challenges of social service delivery to persons with disabilities in egypt

The American University in Cairo

School of Global Affairs and Public Policy

Challenges of Social Service Delivery to Persons

with Disabilities in Egypt: A Stakeholders’ Analysis

A Thesis submitted to

Public Policy and Administration Department

In partial fulfillment of the requirements for

Master of Public Administration

By Amira Ayman El Refaei

Under the supervision of Dr. Ghada Barsoum

January, 2016

i

The American University in Cairo

School of Global Affairs and Public Policy

Department of Public Policy and Administration

CHALLENGES OF SOCIAL SERVICE DELIVERY TO PERSONS WITH

DISABILITIES IN EGYPT: A STAKEHOLDERS’ ANALYSIS

Amira Ayman El Refaei

Supervised by Professor Ghada Barsoum

ABSTRACT

Social Rehabilitation Offices are one of the most vital outlets in Egypt that provide services to

persons with disabilities (PWDs) under the supervision of the Ministry of Social Solidarity

(MoSS). This study seeks to document the performance of Social Rehabilitation Offices from

a multi-dimensional perspective; persons with disabilities (beneficiaries), Rehabilitation

Offices (service providers), partner non-governmental organizations (NGOs) working in the

field of disability, and MoSS (regulators). A mixed methods approach was used to gain an in-

depth perspective to the complexity of the issues present in the Egyptian social service delivery

system. It was clear that not all Rehabilitation Offices are performing with the same quality,

efficiency and effectiveness. The service providers and regulators hold more positive views

towards the services provided by the offices than beneficiaries. PWDs are not able to exercise

their full rights as a result of receiving little information about the services. More effort can be

done regarding the training and employment of PWDs. Also, the study shows lack of clarity of

roles and responsibilities for several stakeholders, which had an impact on the quality of

services provided. Structural issues such as lack of coordination among multiple stakeholders,

poor financial support, a weak monitoring system, and weak social support to PWDs were also

found to negatively impact the quality of services. Recommendations for enhancing the

performance of these Rehabilitation Offices and the overarching system are listed.

ii

List of Acronyms

MoSS Ministry of Social Solidarity

CRPD Convention on the Rights of Persons with Disabilities

SIO Social Insurance Officers

CAPMAS Central Agency for Public Mobilization and Statistics

PWDs Persons with Disabilities

GDSR General Department of Social Rehabilitation for PWDs

JICA Japan International Cooperation Agency

SRV Social Role Valorization

HIO Health Insurance Organization

RTW Return To Work

NCDA National Council for Disability Affairs

NGOs Non-Governmental Organizations

DPOs Disabled Persons Organizations

MoHP Ministry of Health and Population

WHO World Health Organization

KPIs Key Performance Indicators

iii

Table of Contents

List of Acronyms ......................................................................................................................... ii

List of Figures ............................................................................................................................. v

List of Tables ............................................................................................................................. vi

Chapter One: Introductory Discussions ..................................................................................... 7

1.1 Introduction................................................................................................................. 7

1.2 Problem statement ..................................................................................................... 8

1.3 Research Question ........................................................................................................... 9

1.4 Background ...................................................................................................................... 9

1.4.1 Overview of Disability .......................................................................................... 9

1.4.2 International approaches to meeting the needs of PWDs ................................ 10

Chapter Two: Egypt’s Approach to Rehabilitation .................................................................. 12

2.1 Egypt’s Political Framework Concerning Disability ........................................................ 12

2.2 Egypt’s Legal Framework Concerning Disability ............................................................ 13

2.3 Understanding the Governing Structure ................................................................... 14

2.3.1 The Ministry of Social Solidarity’s Mandate ........................................................... 14

2.3.2 Rehabilitation Offices’ mandate and implementation mechanism .................. 16

2.3.3 Relationship between MoSS Social Rehabilitation directorates, the General Department of Social Rehabilitation for PWDs and the Rehabilitation Offices .............. 17

Chapter Three: Literature Review............................................................................................ 19

3.1 Literature on impact of the organizational context on the performance of social welfare administrators ......................................................................................................... 19

3.2 Literature on problems of multiple stakeholders in service delivery ....................... 20

3.3 Literature on subjectivity of service providers ......................................................... 22

3.4 Literature on perception of the direct service providers/ gatekeeper ..................... 24

3.5 Literature on clients’ perception ............................................................................... 25

3.6 Literature on the effect of social support on the perception of services ................. 26

3.7 Literature gap ............................................................................................................ 27

Chapter Four: Conceptual Framework and Methodology ....................................................... 28

4.1 Conceptual Framework ............................................................................................. 28

4.2 Methodology ............................................................................................................. 30

4.2.1 Study Framework ............................................................................................... 31

4.2.2 Research Method ............................................................................................... 32

4.2.3 Study Limitations ............................................................................................... 36

iv

Chapter Five: Study Findings on Perceptions of Services and Human Resource Issues .......... 38

5.1 Evaluating Rehabilitation Offices’ Services ............................................................... 38

5.1.1 Stakeholders’ Perspectives on the performance of social Rehabilitation Offices .. 38

5.1.2 Responsiveness to Clients’ Needs ........................................................................... 39

5.1.3 Factors of Variation ............................................................................................ 41

5.1.4 Evaluating Rehabilitation Offices’ services for the Employment of PWDs ........ 43

5.2 Issues relating to Human Resources ......................................................................... 48

5.2.1 Disparity in Knowledge ........................................................................................... 48

5.2.2 Clarity of roles and responsibilities: Rehabilitation Offices’ responsibilities .... 51

5.2.3 The need to invest in service providers ............................................................. 55

Chapter Six: Study Findings on Structural Issues Affecting Service Delivery ........................... 58

6.1 The involvement of multiple stakeholders .................................................................... 58

6.2 Poor financial subsidies.................................................................................................. 59

6.3 Weak Monitoring system ............................................................................................... 64

6.4 Reviewing assignment contracts and providing equal opportunities ........................... 68

6.5 Weak Social Support to PWDs ....................................................................................... 71

Chapter Seven: Conclusion and Recommendations ................................................................ 74

7.1 Conclusion ................................................................................................................. 74

7.2 Recommendations .................................................................................................... 75

References ............................................................................................................................... 78

Annex ....................................................................................................................................... 83

Annex I: PWDs Questionnaire .............................................................................................. 83

Annex II: Social Rehabilitation Offices Questionnaire ......................................................... 91

Annex III: Rehabilitation Directorate Employees Questionnaire ......................................... 97

Annex IV: NGOs Questionnaire .......................................................................................... 102

v

List of Figures Figure 2. 1 The General Department for Social Rehabilitation Service Outlets ..................... 16

Figure 4. 1 A comparison between the Egyptian Legal framework and the CRPD’s Legal

framework ................................................................................................................................ 29

Figure 4. 2 A process model for Institutionalizing a Rights Based Approach ........................ 30

Figure 5. 1 Stakeholders’ rating to the Rehabilitation Offices quality of services .................. 39

Figure 5. 2 Are the services and benefits provided by Rehabilitation Offices to PWDs

sufficient? (Directed to Rehabilitation Offices) ....................................................................... 40

Figure 5. 3 Do you think PWDs were satisfied/ unsatisfied by Rehabilitation Offices?

(Directed to PWDs).................................................................................................................. 41

Figure 5. 4 PWDs rating Rehabilitation Offices accessibility & cleanliness .......................... 42

Figure 5. 5 The kinds of services received by PWDs from Rehabilitation Offices ................. 44

Figure 5. 6 How do Rehabilitation Office employees determine the suitable job type for the

PWDs ....................................................................................................................................... 45

Figure 5. 7 PWDs (respondents) qualification/ education level .............................................. 46

Figure 5. 8 How do you (PWDs) rate the effectiveness of the training provided by the

Rehabilitation Offices? ............................................................................................................ 47

Figure 5. 9 Do you (Rehabilitation Offices’ employees) follow-up with your beneficiaries? 47

Figure 5. 10 Do you think the services provided by the offices makes PWDs live

independently? (Directed to Rehabilitation Offices’ employees) ............................................ 48

Figure 5. 11 The benefits of Disability ID as mentioned by Rehabilitation Offices ............... 49

Figure 5. 12 Were the benefits of the Disability ID explained to you (PWDs) during your visit

to the Rehabilitation Offices? .................................................................................................. 50

Figure 5. 13 What are the benefits that the Disability ID entitles you (PWDs) to? ................. 50

Figure 5. 14 Were the procedures explained to you (PWDs) upon your request of a service

from the Rehabilitation Office? ............................................................................................... 51

Figure 5. 15 What are the additional services that you (Rehab offices’ employees) think

Rehabilitation Offices’ could provide? .................................................................................... 52

Figure 5. 16 What is needed to meet these additional services? (Directed to Rehabilitation

Offices employees) .................................................................................................................. 53

Figure 5. 17 What are the additional services that can be provided by the Rehabilitation

Offices? Directed to the directorates’ employees .................................................................... 54

Figure 5. 18 What are the additional services that Rehabilitation Offices need to provide to

PWDs? Directed to NGOs ....................................................................................................... 55

Figure 5. 19 In case you (PWDs) were a decision maker, what are the changes that you would

adopt to improve the performance of Rehabilitation Offices? ................................................. 55

Figure 5. 20 In case you (NGO employee) were a decision maker, what are the changes that

you would adopt to improve the performance of Rehabilitation Offices?............................... 56

Figure 5. 21 Number of working years rehabilitation employees spent in Rehabilitation

Offices ...................................................................................................................................... 57

Figure 6. 1What is the timeframe that took PWDs to receive the services? ............................ 59

Figure 6. 2 What are the additional resources and capacities that could enable you (Rehab

office employees) to provide better services to PWDs? .......................................................... 60

Figure 6. 3 Biggest Challenges you (Rehabilitation Offices employees) face during your

work?........................................................................................................................................ 62

vi

Figure 6. 4 If you were a decision maker, what are the measures that you (Rehabilitation

Office employees) would take to improve the performance of Rehabilitation Offices? ......... 62

Figure 6. 5 What is the kind of support that the directorate can provide to the Rehabilitation

Offices? Directed to directorates’ employees .......................................................................... 63

Figure 6. 6 What is the biggest Challenge facing the performance of Rehabilitation offices?

Directed to directorates’ employees......................................................................................... 64

Figure 6. 7 How are the complaints monitored? Directed to the directorates’ employees ...... 65

Figure 6. 8 How do you (directorates’ employees) evaluate the performance of Rehabilitation

Offices? .................................................................................................................................... 66

Figure 6. 9 Actions taken against Rehabilitation Offices in case of violations (directed to the

directorates’ employees) .......................................................................................................... 66

Figure 6. 10 How was this complaint handled? Directed to PWDs......................................... 67

Figure 6. 11 What are the reasons behind the weakness in the performance of Rehabilitation

Offices? Directed to NGOs ...................................................................................................... 68

Figure 6. 12 What do you think of the assignment contracts system that MoSS adopts?

Directed to NGOs .................................................................................................................... 69

Figure 6. 13 What is the most important and fundamental role that the government should

play in the protection and empowerment of PWDs? Directed to NGOs ................................. 69

Figure 6. 14 How would you recommend the assignment contracts to take place? Directed to

NGOs ....................................................................................................................................... 70

Figure 6. 15 What is the kind of support that you would need from MoSS in case you are on

assigned contracts? Directed to NGOs .................................................................................... 71

Figure 6. 16 What are the reasons for the provision of weak services by Rehabilitation

Offices? Directed to PWDs ...................................................................................................... 72

List of Tables Table 4. 1 Stakeholders' Data .................................................................................................. 34

Chapter One Introductory Discussions

7

Chapter One: Introductory Discussions

1.1 Introduction

One of the most pervasive issues affecting the development of nations across various

borders is the issue of disability. Providing the disabled with the basic services is the first step

to allow for their inclusion and empowerment. Recognizing and meeting the PWDs’ needs,

working on social protection and rehabilitation programs and equitable access to basic rights

is a must. The need to address the issue of disability and the extent to which it affects

development become very pressing in light of the first-ever World Report on Disability

statistics; which estimates that 15% of the world population, of which 80% hail from

developing countries, live with some sort of disability (WHO, 2015).. This shows how

disability is a very problematic issue for developing countries. Disability contributes to a

vicious cycle entangling PWDs into a poverty trap because of the limited access PWDs have

to earning livelihood, education, employment and social activities. Not only do PWDs suffer

from lack of inclusion in most developing countries but also from poor services. It is estimated

that 96-97% of disabled people in developing countries have no access to the rehabilitation

services and should be enabled to participate in the society (Integrated Programme to Promote

the Rights of Persons with Disabilities in Egypt, 2011). Yet, according to Article 26 in the

Convention on the Rights of Persons with Disabilities (CRPD), States Parties shall take

effective and appropriate measures, “to enable persons with disabilities to attain and maintain

maximum independence, full physical, mental, social and vocational ability, and full inclusion

and participation in all aspects of life. To that end, “States Parties shall organize, strengthen

and extend comprehensive habilitation and rehabilitation services and programmes,

particularly in the areas of health, employment, education and social services” (Convention on

the Rights of Persons with Disabilities, 2006).

Although Egypt had signed the CRPD in 2007 and ratified it in 2008, its situation

remains similar to many developing countries (United Nations Treaty Collection, 2016). After

a long time ignoring the issue of disability, PWDs started voicing their concerns through

political mobilization in demand of their basic human rights with the rise of the Arab Spring.

With the increased awareness of the need of services that is to be provided to PWDs and the

importance of inclusion; assessing and evaluating the current services provided to the disabled

is very important. This evaluation is to take place in terms of its scope, quantity, quality and

8

effectiveness. In this attempt this thesis focuses on the social services provided by Ministry of

Social Solidarity (MoSS), since it is a key ministry in running services to PWDs. It is, according

to an interview with the Minister Assistant for Social Care and Development at MoSS that 60%

of the services provided to the disabled population resides under the Ministry’s mandate (MoSS

Minister Assistant, 2015). Therefore, this thesis will focus on one of the most vital service

delivery outlets; Rehabilitation Offices which are run by NGOs that fall under the authority of

MoSS. Given that, an exploratory approach will be adopted attempting to examine the multi-

dimensional assessment of the Rehabilitation Offices from a stakeholders’ perspective; (1)

persons with disabilities (beneficiaries), (2) the Rehabilitation Offices (service providers), (3)

Ministry of Social Solidarity’s directorate employees (regulator), and (4) other NGOs working

in the field of disability. This will be carried out through a mixed methods approach to come

up with a stakeholders’ analysis for the services provided by the Rehabilitation Offices. The

information that would be gathered will allow for a careful assessment of the perception of

services based on quantity, quality, its efficiency and availability. It will give an indicative

sample of the familiarity of different stakeholders to Rehabilitation Offices and their access to

it. This is to help in guiding policy makers (MoSS); acting as an indicator to the wellbeing of

the services provided as well as giving room for improvements, better planning and

amendments to better suit the public.

1.2 Problem statement

Given the rising voices and anger expressed by PWDs since the Egyptian 2011 revolution,

there has to be an assessment of the services provided to PWDs in order to know how it can be

improved. Very poor documentation of the services offered by MoSS were found to be

published nor were there assessments to have taken place to Rehabilitation Offices serving

PWDs since the revolution. This weak documentation of the current services hinders the

assessment of the current situation and the analysis of the problems that are to be addressed by

civil society or the government.

9

1.3 Research Question

How are the social services regulated by the government perceived by the public? How are

Social Rehabilitation Offices perceived by the different stakeholders; beneficiaries, service

providers, regulators and service providers in the same field? What are the gaps hindering a

better service provision?

1.4 Background

This section gives an overview of the issue of disability reflecting on some statistical

information from Egypt. It also taps onto the different approaches adopted by different

countries in tackling the issue of disability, the services they provide and the policies they

adopt.

1.4.1 Overview of Disability

The recent high prevalence of disability rates has been traced to patterns of dire

circumstances including healthcare conditions, environmental disasters as well as conflicts.

The World Bank estimates that PWDs may account for as many as one-fifth of the world’s

poor. There are at least 400 million disabled people living in developing countries representing

a minority of unseen and most vulnerable communities (UN News Centre, 2008). During the

high level meeting on disability and development, the UN General Assembly acknowledged

that people with disability face a greater risk of living in absolute poverty. According to the

UNDAF country report “Integrated Programme to Promote the Rights of Persons with

Disabilities in Egypt,” “Disabled adults of working age are three times more likely to be

unemployed and live in real poverty” (Integrated Programme to Promote the Rights of Persons

with Disabilities in Egypt, 2011).

As a result of the absence of inclusion, PWDs suffer from poor health and education

outcomes that affect their self-esteem, opportunities for participation and interaction with

others, which puts them at higher risk of violence, abuse and exploitation. The statistics from

the UNDAF country report reflects that, “Disabled women are 2-3 times more likely to suffer

sexual abuse and other forms of exploitation than non-disabled women” (Integrated

Programme to Promote the Rights of Persons with Disabilities in Egypt, 2011). During the

High Level Meeting (HLM) on 23rd of September 2013; “The way forward: a disability

inclusive development agenda towards 2015 and beyond” the barriers that disability face to

10

equal right and inclusion were discussed (World Report on Disability, 2011). Vulnerable

populations such as women, elderly and the poor were found to be excessively affected by

disability according to the report.

A lot of factors had been identified as contributors to the dire conditions under which PWDs

live. The most important of these are the insufficient policies and standards especially in the

field of education inclusion, negative attitudes from key persons (service providers), lack of

service provision such as healthcare and rehabilitation, lack of accessibility to transportation,

absence of data on disability, poor funding, as well as poor communication, consultation and

involvement to PWDs (World Report on Disability, 2011). Although “inclusion” and

“empowerment” are two key words continuously cited and referred to in international

organizations and countries’ announced strategies and policies when dealing with PWDs,

countries had approached this differently.

1.4.2 International approaches to meeting the needs of PWDs

Different international approaches had been implemented in order to support people with

disability. Services vary between disability benefits (social pensions and monetary benefits),

rehabilitation programs, accessibility provision and psychological support. Developed

countries such as Taiwan usually provide disability benefits (financial support) as well as social

welfare services (parking permits, monetary and social privileges, assistive technology

allowances, nursing care and home rehabilitation services) (Wen-Ta Chiu et al., 2013). This is

mostly the case in all developed countries, since these are the basic services that ensure social

protection of its disabled population. The US has Work Centers or the Community

Rehabilitation Programs (CRP) that provide rehabilitations services, training, and employment

activities in addition to providing support services such as transportation, therapy and

counseling (World Report on Disability, 2011). In addition, the US Department of Labor’s

wage and Hour Division grants its disabled citizens special minimum wages based on their

disability certifications (Employment of People with Disabilities through FLSA Section 14(c),

2016). In Sweden, Norway, and the UK not only does the disabled receive welfare benefits but

services are also extended to the “incapacitated for work due to a loss of function that clearly

is caused by disease or injury” are entitled to sickness benefits (Reiso, Nygård, Brage,

Gulbrandsen, & Tellnes, 2000).

As for developing countries, who are still lagging behind in the inclusion of their

disabled populations, it was found that although the rhetoric used and announced attempts a

11

rights based approach, there is a gap between it and its implementation on the ground. Although

India, provides disability monthly pensions, poverty alleviation schemes, travel benefits and

aid devices to its disabled populations, other problems may deprive PWDs of these benefits

(Kumar, 2014). Since nearly all systems, require medical certifications, for the provision of

these services it was found that in India for example, 80% of PWDs were found with no medical

certifications due to ignorance or lack of services and therefore with no attainment of these

services (Kumar, 2014). In Peru, informal caregivers are much more common than

rehabilitation services provided by the government (Bernabe-Ortiz, Diez-Canseco, Vásquez,

& Miranda, 2015). Other countries such as Thailand are approaching disability from a medical

perspective rather than a rehabilitative one. The disabled tend to be viewed as a cared for group

and therefore there was no inclusion for them in policy making and implementation (Bualar,

2010). This approach of “pity” to deal with the issue of disability was revealed through

studying the case of Pakistan in “Measuring Support Provisions for People Living with

Disabilities in South Asia: An Accessibility Index.” It was found that the government had

adopted the traditional cost and benefit approach that considered the disabled as

“unproductive” or high risk groups (Ahmad & Ahmad, 2011). However, on the other hand a

lot of the South Asian countries such as Afghanistan, Bangladesh, India, Nepal, Pakistan, and

Sri Lanka had went through legislation reform as well as developed national policies for

governing the integration and mainstreaming of the disabled groups in society (Ahmad &

Ahmad, 2011). Therefore, as much as it is important to developing the systems for the social

service delivery, it is important to assess the problems pertaining to these services in order to

allow for an effective mechanism that serves PWDs

Chapter Two Egypt’s Approach to Rehabilitation

12

Chapter Two: Egypt’s Approach to Rehabilitation

The Egyptian context is introduced in terms of the current situation, the political and

legal frameworks as well as the governing structure for the social service delivery system.

Furthermore, in order to be able to rightly assess the performance of the Social Rehabilitation

offices under the supervision of MoSS then one must understand the mandates, roles and

responsibilities of the stakeholders involved in this service delivery process. The following

section will start explaining the role of MoSS towards the issue of disability as well as its

relationship with Rehabilitation Offices, the mandate for these Rehabilitation Offices, the

relationship between MoSS, the offices and the directorates. The below information had been

gathered through in depth research, interviews with the related stakeholders and a desk review

of the laws and bylaws governing the social service delivery system.

2.1 Egypt’s Political Framework Concerning Disability

According to the Central Authority for Public Mobilization and Statistics

(CAPMAS), the official bureau for statistics in Egypt, the number of PWDs in 1996 was

284,702 which was only 0.48% of the population (El Deeb, 2005). In the “Country Profile

on Disability: Arab Republic of Egypt” issued by the Japan International Cooperation

Agency (JICA), Planning and Evaluation Department in 2002, it was reported on behalf of

CAPMAS that the disabled population was about two million people representing about

3.5% of the total population (Country Profile on Disability Arab Republic of Egypt, 2002).

According to the governmental statistical announcement the years of 2006/2007 estimates

the number of disabled to be 2.490.126, 2011/2012 estimated for 2.686.476 and 2.899.180

for the years of 2016/2017 (State Information Service, 2009). These nationally reported

statistics are far away from the international statistics reported by organizations such as the

WHO, World Bank and other international institutions. This exemplifies a huge gap

between the local and international statistics on disability rates. This discrepancy in figures

could be attributed to a set of factors but not limited to; customs and traditions that find

disability shameful and therefore refuse to report them, lack of societal awareness,

inefficiency of the data collectors and the debatable definition for disability. However, in

light of these gaps, there is no statistics on PWDs living in poverty and their proportion of

the 19.6% living below the lower poverty line (World Food Programme, 2016). Egypt is


13

waiting for its next official census report on the national disability rates, which takes place

every 10 years, to be published in 2016 (Population, 2015).

Regardless of the debatable numbers that are announced by the government for PWDS,

in 2002 JICA had announced that the Egyptian government delivers services to only 10% of

its disabled population (Country Profile on Disability Arab Republic of Egypt, 2002). This

figure is very indicative and explanatory of the anger and outrage that has been expressed by

PWDs since the 25th of January revolution. Recognizing the rising voices of PWDs after the

2011 revolution, former Prime Minister Kamal El Ganzouri established the National Council

for Disability Affairs (NCDA) attempting to respond to the disabled population’s needs (Salah,

2012). With more mobilization and calling for the basic rights of PWDs, Egypt had witnessed

recognizable changes in its 2014 constitution; where PWDs were mentioned in nine clauses.

The most recognizable was clause (81) stating that “The State shall guarantee the health,

economic, social, cultural, entertainment, sporting and educational rights of persons with

disabilities and dwarves, strive to provide them with job opportunities, allocate a percentage of

job opportunities to them, and adapt public facilities and their surrounding environment to their

special needs. The State shall also ensure their exercise of all political rights and integration

with other citizens in compliance with the principles of equality, justice and equal

opportunities” (Constitution of the Arab Republic of Egypt, 2014). This is a very inclusive

clause that touches upon all life aspects and cross sectorial rights and services that PWDs are

in need of in order to live independently and empowered. However, this clause still needs

further translation and detailing in terms of laws that can be enforced.

2.2 Egypt’s Legal Framework Concerning Disability

The Egyptian Social Rehabilitation of Disabled Persons law number 39 of 1975,

amended in 1982, intended to protect the rights of disabled people had been introduced as the

first comprehensive disability law in Egypt, to bring disability policy under one framework.

Most of the aspects of these laws, which discuss rehabilitation, training and employment are

dedicated to be implemented by one department at MoSS (General Department of Social

Rehabilitation for PWDs) and involve other ministries such as the Ministry of Labor and

Manpower. Even in the Childhood Law number 12 for the year 1996, the state should provide

“rehabilitation services, technical aids and appliances free of charge and according to the

budget allocated for this purpose” (Meadows, Bamieh, & Lord, 2015). In addition, the law

asserts the MoSS’s role in providing rehabilitation through establishing institutions that would


14

serve Children with disabilities. MoSS is the rule setter and regulator of the whole field of

rehabilitation for any institution/ body that attempts to operate. However, not all benefits are

acquired from MoSS, reduction on custom duties for specially equipped private vehicles take

place through another certification process at the Ministry of Health and Population (MoHP).

The Specialized Medical Committees is the concerned entity belonging to MoHP that is

mandated to certify the case of disability that would allow a person to receive this benefit.

Since the issue of disability had only been covered comprehensively in the

Rehabilitation law number 39, policy makers and other stakeholders tend to attribute the

disability rights and issues to rehabilitation only (Hagrass, 2005, p. 158). Clause number two

defines a PWD as “any individual who became unable to depend on him/herself in performing

his/her work or another [type of] and remains in it. His/her inability to do so is the result of

physical, mental, sensory or congenital impairment” (Hagrass, 2005, p.158). Rehabilitation had

also been defined in this law; “presenting social, psychological, medical, educational, and

professional assistance to all disabled persons and their families to enable them to overcome

the negative consequences resulting from impairment” (Meadows, Bamieh, & Lord, 2015).

These clauses are the guiding base for social service delivery entitlements and will be discusses

later in the conceptual framework.

2.3 Understanding the Governing Structure

2.3.1 The Ministry of Social Solidarity’s Mandate

The Ministry of Social Solidarity is mandated to protect and promote social welfare,

rehabilitation, protection and empowerment of people with disability in Egypt. It, thus, aims to

proffer quality services, empowerment mechanisms and advocacy initiatives to fulfil their

rights as equal persons and citizens. It is mandated to “prepare policies to care for persons with

disabilities, and issues licenses to non-governmental organizations (NGOs), which provide

rehabilitation services, physical therapy, intellectual education, and other social services for

persons with disabilities” (Country Profile on Disability Arab Republic of Egypt, 2002). The

Ministry is also concerned with issues relating to training and employment, advocacy,

education, accessibility, sports and leisure, and is responsible, among others, for the social and

economic rehabilitation of PWDs through integration programs.

There are two specific departments inside the Ministry that serve PWDs; General

Department for Social Protection and the General Department of Social Rehabilitation for


15

PWDs (GDSR). The social protection department grants social pensions to the disabled based

on a medical certification (if it certifies the applicant of more than a 50% disability degree) that

is provided by the client from the Health Insurance Organization based on the Social Security

Act No. 87 of 2000 (Social Security Law number 87, 2000). There is also an “inability” pension

that is based on the same standards. These pensions are granted as part of the wider pension

system that is provided to poor families, widows and the divorced. The General Department of

Social Rehabilitation for PWDs is the official authority that is to serve, care for, protect and

empower the disabled people in Egypt. According to an official document that talks about the

mandate and role of the General Department of Social Rehabilitation for PWDs, the mandate

is as follows. It sets, supervises and monitors the general policies of the ministry in the

protection and rehabilitation of the PWDs as well as the programs that serves them. Since the

ministry itself does not directly provide any direct services, NGOs are delegated for that

mission under the authority of the ministry. The Ministry has a supervisory and regulatory role

over NGOs in addition to a role that involves assigning projects and allocating budgets to

NGOs for its execution, serving a strategic plan. The service delivery mechanisms/ outlets are;

Rehabilitation Offices, comprehensive rehabilitation centers, nurseries for children with

disabilities, mental education institutions, multiple disabilities’ institutions, care and

rehabilitation institutions for PWDs, care and rehabilitation institutions for the deaf, prosthetics

and orthotics workshops, psychological guidance centers, vocational evaluation centers, and

Physio-therapy centers, and a speech therapy center as shown in Figure 2. 1 (GDSR, 2014).

According to the General Department for Social Rehabilitation (GDSR) statistics there are 604

rehabilitation institutions that served 199,618 PWDs during the year of 2014 (GDSR, 2015).

The GDSR is mandated to set out its programs and projects with its implementing bodies

according to its yearly plan or its 5 year plan. The department is also mandated to manage the

financial planning, statistical analysis, quantity and quality of services provided in the social

care and rehabilitation services in Egypt. It participates in the research and development of

social rehabilitation services on both local and international levels in cooperation with local,

regional and international agencies. It also sets and monitors the execution of the Ministries’

policies towards PWDs in the field of social care and rehabilitation.


16

Figure 2. 1 The General Department for Social Rehabilitation Service Outlets

2.3.2 Rehabilitation Offices’ mandate and implementation mechanism

Rehabilitation Offices is one of the Ministry’s mechanisms for providing services to

PWDs. All offices are run by NGOs, however there are two kinds of systems running these

offices. There are some NGOs on assigned contracts from the ministry (191 offices) and other

NGOs that are self-sustained (16 offices), both with a total of 81,124 beneficiary for the year

of 2014 (GDSR employee, 2015). All of the Rehabilitation Offices on assignment contracts

receive yearly financial subsidies as well and both types are regulated and supervised by MoSS.

Rehabilitation Offices are mandated to provide a range of different services to PWDs and their

families:

Issuing Disability IDs

Issuing Rehabilitation certifications to degree and non-degree holders for employment

purposes

Provide vocational training for non-degree holders

Referral services for physical therapy as well as prosthetics services


17

Societal awareness activities (symposiums, seminars, etc)

Holding studies on disability issues (early detection, and dealing with PWDs families)

Assisting PWDs in employment (public, private sectors as well as productive projects)

Following up with those who are employed during the first year to solve any problems

that they may face and provide monthly reports on their situations to the oversight

committee and board of directors

The Disability IDs as well as the rehabilitation certifications gives PWDs an access to

some advantages. The Disability ID gives access to benefits such as discounts on transportation

and public spaces. As for the rehabilitation certifications, according articles 9, 10 and 11 of the

Rehabilitation Law, PWDs are to be employed in 5% of the total number of jobs within any

company that has more than fifty workers where this includes the private sector companies,

third level administrative system of the state, public bodies, entities and economic units”

(Social Rehabilitation Law number 39, 1975). Both the rehabilitation certifications and

disability IDs are of the highest usage among PWDs, since they serve all kinds of disabilities.

The procedures for gaining these services is as follows; PWDs head to the office and fill an

application form, they go through an examination process with a psychologist, a social worker

and a vocational specialist. It is then mandatory for the PWD to go for a medical examination

at the nearest HIO office for a medical certification. Since, this medical certification is only a

guiding one the applicant’s file is compiled and sent to a screening committee (formed on the

level of each office).This committee assesses the eligibility of applicants for the IDs and

rehabilitation certifications. It is composed of a physician, the Rehabilitation Office manager,

MoSS directorate representative, a vocational specialist, and two representatives from the

Ministry of Manpower (one of them is a work safety specialist). This system reveals the

involvement of multiple stakeholders in the process from different ministries (Ministry of

Social Solidarity, Ministry of Health and Ministry of Labor and Manpower).

2.3.3 Relationship between MoSS Social Rehabilitation directorates, the

General Department of Social Rehabilitation for PWDs and the

Rehabilitation Offices

The Ministry of Social Solidarity like other service ministries has branches in every

governorate for its representation and monitoring of service delivery. In each of the 27


18

directorates there is a representative department for the General Department for Social

Rehabilitation. The GDSR is to cooperate and coordinate with the social solidarity directorates

regarding the performance of institutions/ offices and any related service delivery outlets

especially the Social Rehabilitation Unit at the directorate. There is also a representative from

Social Solidarity directorate at the Rehabilitation Offices involved in the screening committee

for the issuance of disability IDs and rehabilitation certificates as mentioned in the previous

section. At the same time MoSS directorates is mandated the oversight of the technical and

financial regulation over these Rehabilitation Offices, as part of its oversight over NGOs.

Chapter Three Literature Review

19

Chapter Three: Literature Review

Systems serving the disabled population differ from one country to another, the

structure and governance in place affects the outcome and performance of these systems. Since

there has been no exact model that matches that of the Egyptian Social Rehabilitation Offices,

looking into similar systems that have the same structure and operating models is very

important. This literature review focuses on the impact of organizational contexts, the systems

and entities in operation, their administrators that act as mediators between the state’s welfare

system and the citizens as well as the perception of the beneficiaries. This literature review

uncovers the social welfare systems’ complexities and the challenges that faces the different

stakeholders involved in the process in addition to the effect of some societal factors on the

perception of the programs/ systems. These are all tackled in an attempt to spot the different

issues affecting the social welfare service delivery.

3.1 Literature on impact of the organizational context on the

performance of social welfare administrators

Some research argues that for a country to be able to improve the effectiveness in

implementation of institutions, the organizational based social contexts have to be examined

(Glisson et al., 2007). Other research suggests assessing the capacity of institutions and the

factors that can enable the environments that would unleash these capacities (Mirzoev, Green,

& Van Kalliecharan, 2015). In a more case specific perspective to analyzing organizational

context, Sweden and Norway were studied. In the 1990s, Social insurance offices’ scope had

been broadened in both Sweden and Norway after the “wok- line” principle reform took place

(Söderberg & Alexanderson, 2005). The tasks of Social Insurance Officers (SIOs) included the

measures to facilitate Return to Work programs (RTW) for the recipients of long term sickness

benefits besides making decisions about sickness benefits. Yet the expansion in the work of

social officers had took place without the sufficient education and training leaving most of their

work to a trial and error mechanism instead of a scientific adopted methodology (Hensing,

Timpka, & Alexanderson, 1997). This can be a very similar situation to that of the Egyptian

system, where the vocational specialist working inside Rehabilitation Offices is the one to

decide what kind or type of work suits the PWDs and based on that he/ she receives vocational

training. Building the capacity of the administrators is an essential cornerstone to the success


20

of the programs, since they are the direct service providers and most effective stakeholder. Yet

little discussion took place regarding the training and education of the social insurance officers’

workers (street level bureaucrats). The next section looks deeper into the specifics of the

involvement of different stakeholders in the service delivery process and its effect on the end

result.

3.2 Literature on problems of multiple stakeholders in service

delivery

The Egyptian system similar to many other countries, involves different stakeholders

in the decision making process of granting welfare services. Both the Scandinavian countries

and Egypt require a medical certification from a separate health institution in order to verify

and help social workers/ committees make the right decisions regarding the clients applying

for a service. Although both systems have committees/ boards for the assessment of the

entitlements to applicants, they use all information collected from social workers in addition to

the medical certifications as an essential guide to make their decisions. The cooperation

between different stakeholders involved in the process becomes problematic during the

execution since each has its own goals and routines. (Ydreborg, Ekberg, & Nilsson, 2007). In

a study using an evaluative literature review for research, it was found out that it is a complex

system that involves several stakeholders with different roles, objectives and priorities (Baril,

Clarke, Friesen, Stock, & Cole, 2003). Conflicts between different groups such as employers,

healthcare professionals, social insurance officers and employability institute officers, arises as

a result of their involvement in the rehabilitation of long-term sickness beneficiaries (Östlund,

Borg, Wide, Hensing, & Alexanderson, 2003). Therefore, this involvement of the different

actors in the decision making process may sometimes result in disharmonized system.

This section will focus on the challenges faced during the Return to Work (RTW) as

well as sickness pension programs in Sweden since it applies a very similar operational model

as the Egyptian Rehabilitation Offices. In an interview study that attempts to uncover the

difficulties that arise for the social insurance officers when assessing applications after this

policy change; it was found that although social insurance boards are given all information by

the social insurance officers in order to make the final decisions, 90% of the board’s decisions

follow the physicians’ recommendations (Ydreborg, Ekberg, & Nilsson, 2007). This shows

how important is the physicians’ perspective in the decision making process. However, since

each system has its different policies, procedures, routines and values that influence their


21

practices, this influences the perception of the clients to the specific welfare program they are

dealing with. Having to wait for the medical examination certificates to be issued by physicians

affected the performance or at least the perception of performance negatively. The waiting

times or lengthy procedure that applicants may face, although was dependent on another entity,

was attributed to the Social Insurance offices (Ydreborg, Ekberg, & Nilsson, 2007).

In a study by Hensing in 1997, SIOs also showed lack of motivation since their work

process involved returning incomplete medical certificates which consumed more of their time

and lengthening of the process (Söderberg & Alexanderson, 2005). This lack of time is said to

have been another reason behind the SIOs acceptance to physicians’ recommendations

(Söderberg & Alexanderson, 2005). The time allocated to each case has been discussed in the

literature as one of the reasons that affects the SIO assessment and entitlement process.

According to the rubber stamping concept developed by Lipsky (1980), public institutions tend

to adopt others’ judgements due to the work overload and time constraints they suffer from

(Hensing, Timpka, & Alexanderson, 1997). This leads to a newly developed culture, that is

more reliant on the system rather than the efforts in customizing the service to clients based on

their needs in light of the rules and regulations in place. However, it could also be that SIOs

had limited information to base their judgements on since the only input they have to base their

judgements is the medical certifications.

In other studies regarding RTW measures, the SIO expressed feelings of ambiguity

when handling clients cases (Söderberg & Alexanderson, 2005). This as well may very much

affect the performance of SIO in serving PWDs. Although, it is the SIOs job to make the final

decision regarding granting the sickness/ disability benefits, and the physician’s is only a

guiding one, SIOs either follow the physicians recommendations blindly through a wait and

see strategy or they use coping mechanisms that may cause them frustration. In a study in

1997, examining the daily dilemmas facing social insurance officers, it was recommended for

physicians and social officers to know more about the work of each other’s system and

requirements in order to be able to make the best decision in favor of their clients (Hensing,

Timpka, & Alexanderson, 1997). The same happens with physicians who determine the kind

of disability, its grade, capacity to work, duration of reduced work ability, and rehabilitation

measures. In the Swedish system, physicians have an even bigger role than the physicians

involved in the assessment process the Egyptian Rehabilitation Offices; they do not only grant

medical certifications that covers diagnosis, treatment and work capacity only but also the

clients’ plans for rehabilitation measures. Same applies to Norway, where general practitioners


22

(GPs) issue more than 80% of sickness certificates (Reiso, Nygård, Brage, Gulbrandsen, &

Tellnes, 2000).

The physicians may sometimes need more information such as insurance legislation

and measures recommended by other professionals. It is not clear in the literature how do

physicians obtain this information in this complex context (Söderberg & Alexanderson, 2003).

In other studies, SIOs expressed that physicians sometimes put clients on the sick list when

they believed they were healthy enough to work (Hensing, Timpka, & Alexanderson, 1997).

Although the evidence in the research would not corner the physicians nor the healthcare

professionals as wrong doers, yet it gives an indication of the fragmentation that exists in the

system of coordination between both parties. Therefore, it is clear that there is a huge problem

of coordination between the different public organizations serving in the welfare system. In a

2007 research conducted on “Swedish social insurance officers’ experiences of difficulties in

assessing applications for disability pensions,” it was suggested that having the SIOs and

physicians coordinating more closely would raise the quality of assessment as well as reduce

waiting times for patients (Ydreborg, Ekberg, & Nilsson, 2007).

3.3 Literature on subjectivity of service providers

Since social officers/ workers are in direct contact with clients they are considered as

street level bureaucrats and so have flexibility and freedom in making decisions that affect the

lives of their clients as well as their economy’s status. In order to grant clients any benefits

from welfare systems, several factors are to be examined and determined before making this

decision. This is a very problematic issue especially in giving percentages for disability levels,

sickness levels and work capacities. Again, the model of the Scandinavian countries concerning

this issue has been studied extensively in the literature, which surely gives a very indicative

sense of the problems that may exist in the Egyptian Rehabilitation Offices. The dual function

that the SIO plays as a coordinator as well as a gatekeeper creates uncertainty in the decision

making process (Söderberg & Alexanderson, 2005). Scandinavian countries, just like the

Egyptian, are mandated to assess the work capacity of their applicants. In Sweden, it is used

for granting the entitled social pensions and at the Egyptian Rehabilitation Offices they are

used for granting the rehabilitation certification as well as determining the work that best suits

the applicant. Social workers or social committees in both countries are faced with the

challenge to determine the entitlement of the disability benefit to the applicant based on factors

that can be viewed differently. The literature goes deep into studying this issue that is claimed


23

to be a subjective process, which is based on employees’ perspective as a result of the

interchangeable factors involved in this process instead of a common basis to make this

assessment. The literature shows that in Western Europe it was difficult to find a unified

assessment (criteria) for disability pension since most had their own assessment tools for this

assessment. The other very important issue is that disability is not classified and set where

PWDs should be blindly classified into, but instead the disabled are very heterogeneous and

their disability differs from one person to the other.

When reassessing the system in place, it was found that in order to decrease sickness

rates in Sweden, those with long term sickness were granted social pensions instead of sickness

pensions (Ydreborg, Ekberg, & Nilsson, 2007). In the 1990s, the social insurance system was

suffering from a huge increase in the number of disabled beneficiaries, which can be attributed

to the subjectivity of SIOs, which led the government to cut down its costs to improve its

economic situation (Ydreborg, Ekberg, & Nilsson, 2007). The disability pension is given due

to reduced work capacity as a result of a medically defined illness. The Swedish legislation

states that people whose work capacity is permanently reduced by 25% are entitled to disability

pensions (Ydreborg, Ekberg, & Nilsson, 2007). Therefore, the need for restructuring this social

system was a must to combat the very high numbers of disabled beneficiaries as a result of the

absence of a solid, clear and comprehensive basis for assessment of the disabled or the sick

applicants. Yet even determining this work incompetency by 25%, for the sickness benefit

entitlement, is still a problematic issue since clients as mentioned before, experience different

kinds of disabilities, living and working environments and socioeconomic contexts. This means

that even by having a criteria it is not a clear cut issue, but one that involves several factors.

Work capacity appears to be a very vague concept with no accurate criteria for assessment used

on behalf of physicians nor SIOs. The assessment of an individual is not solely concerned with

his/her functional abilities but also with his/ her occupation and employment situation

(Hensing, Timpka, & Alexanderson, 1997). The complications of each client’s case, the

changing labor market and unemployment were all factors that further complicate this

assessment. All of these different factors make the assessment system complicated and leave

the entitlements to the subjectivity of service providers being social workers or physicians.

They, furthermore, jeopardize the quality of work and outcome of these social insurance offices

that act as vital decision makers affecting both the daily lives of PWDs and the state’s economy.


24

3.4 Literature on perception of the direct service providers/

gatekeeper

The perception and challenges faced by the gatekeepers (whether social workers or

social committees) needs to be taken in considerations since they are the direct administrators

of the process. Understanding their experiences in the social welfare system is essential to the

improvements of service delivery and effectiveness of the process. In a literature review study

made by Soderberg and Alexanderson in 2005, “Gatekeepers in Sickness insurance: a

systematic review of the literature on practices of social insurance officers” it was found that

although 16 studies dealt with different dimensions of managing clients, only two tapped on

the problems experienced by SIOs in the process of granting sickness benefits (Söderberg &

Alexanderson, 2005). More research needs to be made in this field to be able to identify the

challenges and address them. Although some of the SIOs felt that they have limited control

over the process and the decision making others had felt they had too much freedom in making

decisions and expressed their need for guidance and leadership (Söderberg & Alexanderson,

2005). The need for a more organized framework from higher authority was expressed on

behalf of SIOs to help in governing relations with other professionals and entities such as

physicians, employers as well as employees. This point very much relates to the earlier section

discussing the effect of having a disharmonized system in place.

In a study that was based on 24 meetings with SIOs and clients by Jonsson in 1997, it

was found that there are four approaches that were used by SIOs with clients. These approaches

were between “being the caring professional, the caring amateur, the bureaucratic

administrator, or the coordinator” and clients that did not adhere to the expectations of the SIOs

were found to be challenging to them (Söderberg & Alexanderson, 2005). The “socio-technical

model of organizational effectiveness”, proves that the social context of an organization

becomes deeply rooted to become part of its identity, shaping the expectations, perceptions and

attitudes of its workers (Glisson et al., 2007). This is said to affect the responsiveness,

availability and quality of service delivery to the beneficiaries. This is not only among different

actors but also among professionals belonging to the same institution. The decision making

regarding the entitlements was found to have been attributed to some of the employees’

characteristics. Work ability was found to be related to the age of physicians in Norway, older

GPs are more compassionate with their patients than the younger ones (Reiso, Nygård, Brage,

Gulbrandsen, & Tellnes, 2000). Therefore, this suggests that personal characteristics and


25

acquired organizational approaches’ effect differ from one service provider to the other. This

means that since service providers act differently, they will not be perceived the same way by

their clients.

3.5 Literature on clients’ perception

Clients’ satisfaction is a key indicator to the quality of services the public/ private

sectors are providing. This part of the literature focuses on the perception of clients and the

relationship that exists between them and the social welfare administrators. The sex, disability

status, rehabilitation measures and pensions of beneficiaries were all factors that are said to

affect the perception of clients towards SIOs. Women beneficiaries perceive SIOs and

healthcare professionals to be more supportive to them than men find them to be (Östlund,

Borg, Wide, Hensing, & Alexanderson, 2003). Furthermore, those who received disability

pensions had more positive views on SIOs than those without disability pensions and those

who had returned to work (Östlund, Borg, Wide, Hensing, & Alexanderson, 2003). It was

found that positive experiences of encounters with rehabilitation professionals from clients may

facilitate return to work by individuals on sick leave (Klanghed, Svensson, & Alexanderson,

2004). However, more research is needed regarding these positive experiences and what they

carry of empowerment to beneficiaries.

Other literature examines how having disabilities is worse for women than men and

how the poor with disabilities are alienated (Ahmad & Ahmad, 2011). This issue of gender bias

was deeply investigated in the literature especially in social insurance offices RTW measures.

Men were granted more expensive measures for rehabilitation than women and workers were

more responsive to their suggestions (Söderberg & Alexanderson, 2005). Women usually

stayed longer on sick leaves and were given disability pensions after a short period of their

absence (Borg et al, 2001). However, in the healthcare sector gender bias has been an issue of

study for long, since gender bias in medical practice exists. In a comparative literature review

study that was conducted in 2005, some of the findings were as follows, SIOs regarded

themselves extremely neutral and that rehabilitation measures were due to external factors that

was not up to them to decide. However, they had acknowledged that women were more difficult

to rehabilitate. It was a common factor that men felt more in control of their situation than

women.

Yet, other factors that were attributed to the quality and quantity of services found in

the literature relating to customer satisfaction were waiting times, process and length of service


26

delivery, amenities/ facilities cleanliness, hygiene, affordability, transparency, privacy, trust,

quantity and quality of direct service providers. On a more general level, clients undergoing

rehabilitation were said to have expressed negative attitudes and perceptions towards the

rehabilitation process. However, this has not been further studied in the literature, so the

reasons behind this negative attitudes cannot be fully claimed.

3.6 Literature on the effect of social support on the perception

of services

Other important factors that had been explored in the literature had been the importance

of social capital and its impact on the satisfaction of the disabled groups. Some research shows

that disabled groups are more satisfied with informal social support rather than institutional

support that is received through governmental or NGOs services. A study that was carried out

in Croatia revealed that the disabled satisfaction is highly related to the amount of social

support they receive from their community and circle; being family and friends. Social

Valorization theory has been developed and discussed a lot in the literature on disability. “The

use of culturally valued means to enable, establish, enhance, maintain, and/or defend valued

social roles for people at value risk” (Wolfensberger, 1985, 1998, 2000) (Aubry, Flynn, Virley,

& Neri, 2013). Social valorization has to do more with the social image of the disabled by

society and the effect that this has on the disabled groups and how they derive their satisfaction

from the perceived image. Self-esteem, satisfaction and expansion of personal competencies is

said to be derived from moving from being de-valued to develop relationships with non-

devalued individuals, through social and physical support outside of the treatment settings

(Aubry, Flynn, Virley, & Neri, 2013). There has been a developed tool for assessing the degree

to which programs and service settings are in line with normalization and SRV principles

(Aubry, Flynn, Virley, & Neri, 2013). This proves the importance of psychological integration

to inclusion and empowerment and its important effect on PWDs perception of services.

Research extends in this area to draw linkages between social roles and social images, where

those who are perceived with positive social roles will be treated well by others while those

who are perceived with negative social roles will be treated badly by others (Wolfensberger,

2000). This could be linked to the way service providers or street level bureaucrats deal with

their clients/ beneficiaries during service delivery. The professional treatment of the social

administrators affects the PWDs perception of services and therefore, the social image created

by the social welfare administrators is very important to take into consideration.

http://onlinelibrary.wiley.com.library.aucegypt.edu:2048/doi/10.1002/jcop.21524/full#jcop21524-bib-0044




27

3.7 Literature gap

The literature uncovers that the performance of the social welfare systems is very much

determined by a combination of factors and multiple actors. Although different perspectives

and factors affecting social welfare program have been discussed in the literature, it was mainly

focused on the experience of Scandinavian countries. There appears to be a literature gap in

covering the Middle Eastern countries experiences and specifically Egypt. Furthermore, more

research needs to consider a holistic approach to the assessment of services by the different

stakeholders; and the perception of the quality of the social services. This will help in

determining the gaps, flaws and challenges in the existing system as well as give space for

solutions to be made.

In light of this research, this thesis attempts to build on the existing literature in the area

of social welfare system performance as well as expand on it by tackling the assessment of

services provided from a multi-dimensional perspective to gain a better understanding of the

services provided to PWDs. Specific factors affecting the perception of services will be deeply

examined in order to determine the current challenges facing the service delivery system and

the possible proposals for solution. This study aims to cover for the dearth of published

literature on Egypt and the Arab/Middle East region.

Chapter Four Conceptual Framework & Methodology

28

Chapter Four: Conceptual Framework and Methodology

4.1 Conceptual Framework

Since the “lack of access to rehabilitation services can increase the effects and

consequences of disease or injury; delay discharge; limit activities; restrict participation; cause

deterioration in health; decrease quality of life and increase use of health and rehabilitation

services”, having a wrong perception of “rehabilitation” could also lead to these same outcomes

(World Report on Disability, 2011). Therefore, setting the right understanding of the concept

of “rehabilitation” is very important. The current Egyptian Rehabilitation law number 39 for

the year of 1975, which has been last amended in 1982, 34 years ago, uses an outdated approach

in tackling the concept of “rehabilitation” failing to see it as one that involves a comprehensive

and integrated humanitarian and social process. In the Social Rehabilitation Offices bylaws

issued by MoSS in 1997, clause (2) states that the office aims to qualify all categories of PWDs

in a manner that is fit to the abilities they have left, being physical, mental or psychological

(MoSS, 1997). The linguistics in use, “fit to the abilities they have left”, reflect a care based

approach with little attention to empowering the PWD to realize his/ her full capacities. This

definition reflects the traditional perspective to disability, which attempts to tackle the issue for

a medical or an individual perspective. It attributes disability to a loss of function which usually

result in the segregation of disabled people since they cannot exercise their lives in a normal

manner. This is very clear in how “rehabilitation” is defined in the Egyptian Social

Rehabilitation Law number 39 as “presenting social, psychological, medical, educational, and

professional assistance to all disabled persons and their families to enable them to overcome

the negative consequences resulting from impairment” (Hagrass, 2005, p. 158). This is a very

different definition than what the Convention on Rights of persons with Disabilities gives to

rehabilitation; “enable persons with disabilities to attain and maintain maximum independence,

full physical, mental, social and vocational ability, and full inclusion and participation in all

aspects of life” (World Report on Disability, 2011). In addition to what it also gives to PWDs;

which is to work on regaining the lost or compromised skills and abilities of PWDs and provide

them with the necessary tools and environment for their full inclusion and empowerment.

These definitions that were given by the CRPD remarks a shift in viewing PWDs from a group

that requires care and protection to a group that holds equal rights to other citizens. This “rights-

based approach to disability seeks to empower disabled persons, and to ensure their active


29

participation in political, economic, social, and cultural life in a way that is respectful and

accommodating of their difference” (UN HRBA, 2016). A visual comparison is illustrated in

Figure 4. 1 by the researcher to better convey the difference between the Egyptian approach

and the CRPD’s in tackling the issue of disability.

Figure 4. 1 A comparison between the Egyptian Legal framework and the CRPD’s Legal

framework

A rights based approach is not one that is to be used on the legislation level only, but

one that can be adopted on an institutional and program levels as well. The United Nations

Development group had adopted the UN Statement of Common Understanding on Human

Rights-Based Approaches to Development Cooperation and Programming (the Common

Understanding) in 2003 (UNICEF, 2016). According to UNICEF, a rights based approach is

“a conceptual framework for the process of human development that is normatively based on

international human rights standards and operationally directed to promoting and protecting

human rights. It seeks to analyze inequalities which lie at the heart of development problems

and redress discriminatory practices and unjust distributions of power that impede development

progress” (UNICEF, 2016). Therefore, analyzing the institutional capacities from a multi-

stakeholders perspective is very important to assessing the gaps in the system. In the


30

researcher’s attempt to use a rights based approach certain measures needs to be taken to realize

that and to reach a better service delivery mechanism. Figure 4. 2 reflects the researcher’s

perspective to institutionalizing a rights based approach and its adoption by NGOs, being

Rehabilitation Offices or any other service delivery outlet in order to deliver full rights and

empower PWDs. The process needs to start with an evaluation assessment of the situation in

order to uncover the capacity of the duty bearer (being the service provider as well as the

regulator of the services). This will allow for the adoption of new organizational concepts and

beliefs that will surely reflect on the activities and measures taken to achieve a rights based

approach.

Figure 4. 2 A process model for Institutionalizing a Rights Based Approach

4.2 Methodology

This study attempts to carry out an exploratory study to examine the multi-dimensional

assessment of the Rehabilitation Offices from the perspective of its stakeholders; (1) persons

with disabilities (beneficiaries), (2) the Rehabilitation Offices (service providers), (3) Ministry

of Social Solidarity’s directorate employees (regulator), and (4) other NGOs working in the

field of disability.


31

4.2.1 Study Framework

Since the researcher is working for MoSS, as a consultant for Disability Affairs, this

study takes place during workshops held by the ministry, targeting the different stakeholder

participants. The aim of holding these workshops was to come up with MoSS’s disability

strategy for the coming three to five years. MoSS launched 16 participatory workshops, during

the months of November and December 2015, four in four different governorates, Cairo,

Alexandria, Assiut and Ismailia, in order to formulate a participatory "Disability Strategy". The

workshops were based on a classification of four main types of disability; physical disability,

visual impairment, deaf and hard of hearing and intellectually disabled. The rationale behind

that was to have a workshop for each of these groups in each of these four governorates. The

invitation of the workshop participants took place according to the geographical location, age,

background and affiliation representation where each workshop was attended by 30 to 40

participants. As for the PWDs they were picked according to their level of activism in the field

or based on the recommendations of prominent NGOs. Since this is a public forum held by

MoSS the researcher attended all workshops, observed and documented the discussions and

issues that pertained to this thesis area of focus.

The researcher gained the approval of the IRB on 4 December, 2015 for using the

appropriate procedures to minimize the risks to human subjects as well as protect their

confidentiality. Since the researcher had to wait for the IRB approval before collecting data,

the questionnaire was used in 12 of the workshops only, starting 6 December, 2015 ; four at

Cairo, four at Assiut, two at Ismailiya and two at Alexandria. The researcher appealed to the

workshop participants to participate in full consent of their will and without any pressure,

coercion and undue inducements, each according to his/ her affiliation. The participants were

informed of having the right to withdraw from the research at any point of time without any

penalty.

The researcher, holding a position of a consultant to the Ministry of Social Solidarity,

attained the approval of the Ministry before starting with the research. Since the researchers is

not an employee at MoSS but instead a consultant, this gives the research an objective

perspective and avoids any conflict of interest during this study.


32

4.2.2 Research Method

This thesis aims to use a mixed methods approach that adopts the “convergent parallel

design” designed by Wittinik, Barg and Gallo (2006) which collects and analyzes the findings

of the quantitative and qualitative simultaneously (Creswell & Clark, 2011). The results are

then combined and laid down to find relationships complementing or contradicting one another.

The idea behind the use of this approach is to map out the complexity of the issues that overlap

in the Egyptian social service delivery system. The collected data will be analyzed and

integrated in this manner to add to the richness of the study and address the complexity of the

manifold challenges that these Rehabilitation Offices exist within. The quantitative method

was used to highlight the shared experiences while the qualitative one was in use to gain the in

depth view of some of the important issues.

Quantitative Component

Before designing the questionnaires that will be in use, the researcher conducted a desk

review to grasp a good understanding of the nature of these offices, the laws and regulations in

use as well as the different stakeholders involved. In order to gain a deeper understanding of

the nature of the work of these offices and their on-the-ground work, three visits were made to

three offices (one in Cairo and two in Giza governorate). The selection of these offices was

randomly selected based on their geographical proximity as well as the recommendation of the

GDSR. Based on this outcome, four self-administered questionnaires were then designed for

the four different stakeholders; PWDs, Rehabilitation Offices employees, NGOs and social

rehabilitation directorate employees (see Annex 1, 2, 3 & 4). The data was deconstructed and

quantified to be able to assess the importance of issues, concerns and views based on the

frequencies. The data gathered was analyzed in a comparative manner to allow for the

withdrawal of analysis from the different perspectives of the different respondents.

Quantitative Sampling

There has been 177 questionnaires distributed during these workshops; 26 answered by

the Social Rehabilitation Offices, 19 by directorate employees, 50 PWDs (45 directly answered

by PWDs and 5 by their guardians with no representation of the intellectually disabled) and 82

by NGOs working in the field of disability (after 3 of the NGOs were eliminated from the

surveys). These NGOs’ applications were eliminated from the surveys since they were filled


33

by NGOs holding/ running Rehabilitation Offices. The reason for that is to maintain the

neutrality of the “NGOs” grouping as a beneficiary (applies for its beneficiaries for benefits)

or a party in the same filed that could provide an evaluation of the Rehabilitation Offices

performance. Of course, there has been a difference between the representations of the different

stakeholders as a result of their proportionate representation to their original size. For example

the rehabilitation directorate employees in one governorate can be an average of two while

NGOs can be around 25 or more in the same governorate.

In regards to the participation of persons with disabilities, only the physically disabled,

visually impaired, deaf and hard of hearing and guardians of the intellectually disabled were

targeted to participate in the “PWDs” questionnaire. Intellectually disabled persons were not

directly included in this study in respect and protection of their rights. Some questionnaires

may be addressed to persons with disabilities using the help of the researcher or a volunteer

due to the incapacity of the disabled to administer the questionnaire on his/her own. These

groups may be some of the physically disabled (upper body limb amputations), the visually

impaired and the illiterate (if any). When communicating with the deaf and hard of hearing

participants a sign language instructor that is also attending the Ministry of Social Solidarity's

workshops will be used as an intermediate to getting the consent of the targeted participant and

explaining the situation. The deaf and hard of hearing person will be doing the questionnaire

by himself/ herself only asking for the sign instructor's help in case he /she needs any kind of

clarification from the researcher.

The questionnaire addressed to persons with disabilities was designed to allow for

drawing correlations based on the kind of disability, gender, age, and education level. It will

also give an indicator of the most common services that is in need or in use by the PWDs. It

will touch upon what is expected of these Rehabilitation Offices by PWDs. The second

questionnaire, addressed to the Rehabilitation Offices employees, will draw correlations based

on the NGO the office belongs to and the characteristics that pertain to the employee being

surveyed. It will also allow to compare some aspects such as the communication of information

(ex: the explanation of the benefits of Disability IDs) with the PWDs receiving the services

from the side of the service provider and the side of the beneficiary. It examines the additional

kind of support that these Rehabilitation Offices is in need of, the biggest challenges they face

and how can they overcome it. As for the third questionnaire, MoSS directorate employees,

takes the perspective of the regulator and how they assess the work done by the Rehabilitation

Offices. It also focuses on how the directorate is fulfilling the role that is assigned to it by

monitoring the performance of Rehabilitation Offices, customer’s satisfaction and the kind of


34

support it provides to these offices. The perception of the “assignment contracts” is another

issue that is explored from the perspective of MoSS directorate as well as the NGOs working

in this field (the fourth questionnaire). This last set of questions address the perception of other

NGOs working in the field of disability to Rehabilitation Offices in terms of their popularity,

efficiency, importance as well as the most important is the system’s operating framework.

Table 4. 1 reflects the basic data gathered about the stakeholders’ sample number,

representation, their geographic distribution and gender.

Table 4. 1 Stakeholders' Data

Stakeholder

Sample number

Sample

representation

Geographic

grouping of the

sample

Gender

representation

of the sample

PWDs

50 PWDs

Respondents type of

disability:

Physical: 48%

Deaf and hard of

hearing: 38%

Visually impaired:

14%

Intellectually

disabled: 0%

Representation

of 17

governorates

Greater Cairo:

32%

Alexandria: 22%

Suez Canal and

Delta region:

12%

Upper Egypt:

34%

Males: 74%

Females: 24%

Social

Rehabilitation

Offices

26 employees These employees

represented 25

Rehabilitation

Office from all over

Egypt which is

11.7% of all offices

(204 offices)

Representation

of 14

governorates

Greater Cairo:

35% (9 offices)

Alexandria: 15%

(4 offices)

Males: 73%

Females: 27%


35

Suez Canal and

Delta region:

23% (6 offices)

Upper Egypt:

27% (7 offices)

Directorate

19 directorate

employees

These employees

representation

covered 12

governorates which

is 44.4% of the

governorates (27

governorates)

Greater Cairo:

36.8%

Alexandria:

36.8%

Suez canal and

Delta region:

15.8%

Upper Egypt:

10.5%

Males: 36.8%

Females: 57.8%

No answer:

5.3%

NGOs

82 employees/

representatives

of NGOs and

DPOs

Both NGOs and

DPOs were

represented. Their

field of work varied

between charity,

capacity building,

providing basic

services, human

rights, research,

awareness,

education,

employment,

rehabilitation, early

intervention,

Representation

of 22

governorates

Greater Cairo:

38%

Alexandria: 16%

Suez Canal and

Delta region:

13%

Upper Egypt:

33%

Males: 45%

Females: 38%

No Answer:

25.5%

Qualitative Component

The surveys’ open-ended questions were coded and grouped based on the common use

of words and meanings. All data will be analyzed using the SPSS program and the results will


36

be analyzed in a thematic manner. The different themes will be drawn out in a selective manner

and would be integrated based on the relations and areas that were mostly discussed/ mentioned

or of concern to the stakeholders. As part of this data transformation model in use, the

qualitative data in the survey will be coded and interpreted. In addition to the questionnaires

extracted data, observations were closely made during the convened workshops regarding the

discussions concerning Rehabilitation Offices. The discussions and comments made by the

related participants were carefully monitored and noted to add to the data analysis process to

add richness and a wider perspective to the issues in hand. Notes and observations were taken

by the researcher during the three field visits that took place at the Cairo and Giza offices during

the data gathering stage (preparatory phase). A total of six Rehabilitation Offices’ employees

were interviewed, a manager and a social worker at each of the offices, where the questions

that were addressed were semi-structured. The selection of the interviewees was dependent on

the availability of these employees’ during the researcher’s visit. They were asked about the

offices’ mandates, the services they provide, and the cycle the clients go through for receiving

the services, the benefits of the services given out to clients as well as the challenges that they

may be facing.

A further analysis was drawn out based on unstructured interviews with three officials,

a manager and two senior rehabilitation specialists, at the General Department of Social

Rehabilitation for PWDs (MoSS), which is mandated to support and monitor the work of the

Rehabilitation Offices. These interviewees were picked based on their seniority and

understanding of the system and its multidimensional aspects. The questions addressed to these

interviewees include inquiring and investigating some of the responses of the stakeholders’

surveys to understand the issues deeper and be able to provide a stronger analysis in presence

of all information. The analysis would also include the use of the bylaws governing the work

of the Rehabilitation Offices and any other relevant documents that is to be made available by

the GDSR. Therefore, the use of this combination of quantitative and qualitative methods will

shed light on the important issues and give a full perspective to the current situation and

problems of the Rehabilitation Offices.

4.2.3 Study Limitations

The plan was to have the representation of the four kinds of disability (physical, visual,

hearing and intellectual), however there was no representation to the intellectually disabled by

their guardians when the data was analyzed. This could have been a result of the attendance of


37

guardians as NGO representatives. It is very much common for the family members especially

mothers to have an active role in the field of disability and therefore a lot of the attendees were

members of NGOs which responded to the stakeholders’ survey as an NGO instead of a

guardian of an intellectually disabled. Also the workshops held by the Ministry were on a full

day schedule, which might have affected the respondents’ quality of answers as they may have

been in a hurry to leave due to other commitments that they may have.

Due to the researcher’s position at the Ministry of Social Solidarity, the respondents

may be negatively affected especially those of the directorates and the Rehabilitation offices.

It may be that they would answer more positively than they would really think so, holding back

from sharing information that might have added to the richness of the study. They may have

been uncomfortable in sharing some of the information so as to avoid any problems or

complexities with their superiors/ seniors. However, the researcher has explained to each and

every respondent before the study that it is an anonymous as well as confidential one and all

his/ her rights is to be protected. Other, possible limitations could also be misunderstandings

regarding the framing of questions or unclear terms to the respondent. An avoidable restrictive

weakness in the study design could exist as a result of the complexity of the issue being studied

and the multiple involvement of stakeholders’.

Chapter Five Study Findings on Perceptions of Services and Human Resource Issues

38

Chapter Five: Study Findings on Perceptions of Services

and Human Resource Issues

Chapters five and six present the findings, discussions and analysis of the study. Since

the findings of the questionnaires resulted in a lot of information, the researcher was selective

to the recurrent issues and important themes. A comparative analysis had been drawn between

respondents of the same questionnaires as well as between different stakeholders. The

discussions and analysis in this chapter starts with the stakeholders’ evaluation of the

Rehabilitation Offices services then would examine the human resource dynamics affecting the

service delivery outcome.

5.1 Evaluating Rehabilitation Offices’ Services

5.1.1 Stakeholders’ Perspectives on the performance of social

Rehabilitation Offices

A common question that was addressed to all four stakeholders in the surveys was

rating their experience at the office or their perspective regarding the quality of services. Figure

5. 1 shows the different ratings that each of the stakeholders gave to the services according to

their experience and individual perspective. The PWDs whom are the direct beneficiaries for

the services of the Rehabilitation Offices gave a better rating along the positive spectrum than

what the NGOs gave when asked about their perspective regarding the experience of PWDs at

Rehabilitation Offices. However, along the negative spectrum PWDs had an 18% (for the weak

and poor services) as opposed to the NGOs that had an 11%. Although this shows that there is

a lot of variance among the answers given by PWDs, half of the respondents find it either very

good/ good.

The Rehabilitation Offices (service providers) and the directorate employees

(regulator) gave more positive rating to the services provided by the Rehabilitation Offices.

The offices’ employees gave a “very good” rating of 46% when asked to evaluate the services

they provide to PWDs. The overall rating of the offices was much better by the offices’

employees than what the directorate employees gave to the offices under their supervision

when asked to rate the efficiency and effectiveness of these offices. Although the directorate

employees are the service regulators, who are supposed to supervise and monitor the work of

these offices, the director of the rehabilitation unit at the directorate is also the decision maker


39

in the entitlement process. The director of the Social Rehabilitation directorate is represented

on the committee that is to assess the applications and come out with the final decision of

whether the applicant is worthy or unworthy of the entitlements. This is problematic in the

sense that the Rehabilitation Office combines between two positions which may lead to conflict

of interest. In light of this, directorate employees’ involvement with the offices’ vary according

to the number of offices in the geographic location of where the directorate supervises. For

those interviewed, 3 of the directorate employees supervise over 3 to 6 offices, 11 supervise

from 8 to 11 offices and 5 employees supervise from 12 to 18 offices. Since the majority of

directorate employees are delegated authority over 8 to 11 offices, this could be too much work

to be done being represented on the entitlement committees as well as having a supervisory

role at the same time. Furthermore, the subordinates of the director of MoSS rehabilitation

directorate could fear to take any actions of investigation against their own managers in case

of any violations.

Figure 5. 1 Stakeholders’ rating to the Rehabilitation Offices quality of services

5.1.2 Responsiveness to Clients’ Needs

It was found that 65% of the Rehabilitation Offices’ employees think that the services and

benefits provided by the Rehabilitation Offices to PWDs are not enough (Figure 5. 2). This

means that more than half of those interviewed believe that there is more that can be done and

there is a huge room for improvement that can be achieved. However, there was no expansion

from there side on that since the researcher did not address a direct question for that. This will

0%

20%

40%

60%

80%

100%

PWDs Rehabilitationoffices

Directorates NGOs

16%

46%

10% 9%

34%

38%

58%

21%

26%

12%32%

35%

6%

4%6%

12% 5%

Rating Quality of services recieved/ provided by Rehabilitation Offices

Very Good Good Average Poor Bad


40

be reflected upon more in depth in the vocational training and employment section that will be

discussed and analyzed later.

Figure 5. 2 Are the services and benefits provided by Rehabilitation Offices to PWDs

sufficient? (Directed to Rehabilitation Offices)

In support of this view, when NGOs were asked about their views regarding the

satisfaction of PWDs towards Rehabilitation Offices, 59% believed they were unsatisfied

(Figure 5. 3). Looking deeper into the rationale behind these ratings, 11 respondents believed

that the services provided does not meet the PWDs needs due to its poor quality and 13

respondents attributed this dissatisfaction to human resource issues. The answers mainly

revolved around the employees’ poor capacities to provide the services needed, their failure to

understand how to deal with PWDs and complicating the procedures PWDs need to receive the

services. Whereas 11 respondents believed that it was the complicated procedures that cause

this dissatisfaction among the PWDs.

31%

65%

4%

ARE THE SERVICES AND BENEFITS PROVIDED BY REHABILITATION OFFICES TO PWDS

SUFFICIENT?(DIRECTED TO: REHABILITATION OFFICE EMPLOYEES)

Yes

No

No Answer


41

Figure 5. 3 Do you think PWDs were satisfied/ unsatisfied by Rehabilitation Offices?

(Directed to PWDs)

5.1.3 Factors of Variation

Some of the addressed issues had been found to have variations in their ratings such as

the accessibility and the amenities/ facilities cleanliness, hygiene and quality of appearance as

evident in Figure 5. 4. It is those factors in addition to others such as waiting times, process

and length of service delivery, affordability, transparency, privacy, trust, quantity and quality

of direct service providers that attribute to customer’s satisfaction and therefore their

perception on the quality and quantity of services provided. This shows that these factors can

depend on every office’s environment, capabilities, competency and friendliness of its

employees. During one of Cairo’s workshops, one of the leading NGOs working on the training

and employment of PWDs, said that

We were dealing with an office at Heliopolis that was really good and very cooperative

when we send those requests for disability IDs for our beneficiaries, but the problem

appeared when we had to deal with other offices that weren’t as cooperative.

The interviewee explained that some of the new offices that they started dealing with could

take from two to three months to issue the IDs, whereas this hadn’t been the case with

Heliopolis office she was dealing with before. This shows that there is a variation between the

performances of offices, each seems to have its own organizational based social contexts, since

all offices are governed by the same bylaws.

17%

59%

24%

DO YOU THINK PWDS WERE SATISFIED/ UNSATISFIED BY THE REHABILITATION

OFFICES?DIRECTED TO PWDS

Satisfied

Unsatisfied

No Answer


42

Figure 5. 4 PWDs rating Rehabilitation Offices accessibility & cleanliness

Although a variation had also existed for the treatment of employees to citizens at the

Rehabilitation Offices and their responsiveness towards citizens’ requests, the treatment of citizens’

had been given lower negative ratings than the responsiveness of employees towards citizens’

requests/ needs. This very well suits the “socio-technical model of organizational effectiveness”

which is built on the idea that the social context are constructed by employees sharing “expectations,

perceptions and attitudes that affect the adoption and implementation of evidence-based practices,

the nature of the relationships that develop between service provider and consumers, and the overall

availability, responsiveness, and continuity of the services (Aarons and Palinkas 2007; Grol and

Grimshaw 2003; Nelson and Steele 2007; Nelson et al. 2006)” (Glisson et al., 2007). Therefore,

the success of service delivery very much depends on the social constructs and contexts as much as

they do on the technical capabilities. They can actually be a stronger force to shaping service

providers behaviors and attitudes towards PWDs more than the rules and regulations set to drive

the service delivery model. These direct administrators or who were earlier referred to in the

literature as “street level bureaucrats” have a relative degree of flexibility and freedom in making

decisions that affect the lives of their customers. The perceptions that the employees of

Rehabilitation Offices (service providers) hold towards the environment they work in and the

challenges they face seem to be contributing to their overall performance. Therefore, this suggests

that personal characteristics and acquired organizational approaches affect the quality of service

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Accessibility Cleanliness Responsivness ofEmployees

General Treatmentof Citizens

How were youtreated by the

employee

Rating Accessibility & offices' Cleanlinessby PWDs

Very Good Good Average Weak Poor


43

provided, which also means that this can differ from one service provider (Rehabilitation Offices)

to another.

5.1.4 Evaluating Rehabilitation Offices’ services for the

Employment of PWDs

“Physiotherapy, occupational therapy, adjustment of the work place, shorter periods of

retraining and investigation of the working capacity at private or public departments” are all

rehabilitation measures that address the needs and capacities of PWDs (Hensing, Timpka, &

Alexanderson, 1997). All of these services are ought to be provided by the Rehabilitation

Offices however, the quality they are provided with needs examination. When looking at the

age groups that were surveyed, most of them were of working age, where 32% of them were

between the ages 18 to 30, 46% were 30 to 45 years of age, and 22% were above 45 years of

age. This implies that they must have had contact with the Rehabilitation Offices to make use

of its services. Given the type of respondents and their age, 92% of them had visited

Rehabilitation Offices seeking its services, the highest need appears to be for the rehabilitation

certificates followed by Disability IDs as shown in Figure 5. 5. However, it was not expected

that the use of Disability IDs would be lower than that of rehabilitation certifications since any

PWD is entitled to a Disability ID regardless of his/ her age, gender or kind of disability. Yet,

this low use of disability ID could be due to the weak benefits that it grants its holders and

therefore there is little motivation for PWDs to apply for. As for the referral services (physical

therapy and prosthetics), its services are mostly provided to the physically disabled and

therefore it only serves a certain segment of PWDs. Also the vocational training mainly takes

place for the non-degree holders and the sample that was surveyed had been mostly degree

holders. Since the highest use of services had been for rehabilitation certifications this shows

the importance of receiving these certifications for employment opportunities. Therefore, this

section will focus on what the office provides to PWDs to achieve that. This will take place

through focusing on the kind of vocational training offered to non-degree holders, assisting in

finding employment opportunities and following up with the beneficiaries who received

rehabilitation certifications whether they were degree or non-degree holders.


44

Figure 5. 5 The kinds of services received by PWDs from Rehabilitation Offices

One of the most discussed topics during the workshops was the kind of training that the

Rehabilitation Offices offer to its non-degree holders. This was only a problem for non-degree

holders since degree holders are granted rehabilitation certifications based on the degree they

hold, involving no training. Attempting to understand the situation more, when the

Rehabilitation Offices’ employees were asked about the existence of a guide that describes the

suitable jobs for different kinds of disability, 62% said they existed. However, during my visits

to the Rehabilitation Offices no guide was said to be available but it was explained that

decisions were made by the vocational specialist in accordance with the skills of the PWD.

Furthermore, when Rehabilitation Offices’ employees’ were asked about the measures taken

to determine the kind of jobs that suits the different kinds of disability, none of them mentioned

anything regarding the guide as shown in Figure 5. 6. The vocational specialist is ought to

discuss the skills and qualifications of the PWD with him/her. This is very much a similar

situation to the assessment of work capacities that social workers go through since it takes place

with no accurate criteria for assessment but rather depends on the skills, experience and

knowledge that the vocational specialist holds. Based on that the PWD either receives the

suitable training or if he/she believes they have a certain skill they will be tested on it. A

rehabilitation certification is then issued with the kind of training received or according to the

vocation the person had been tested on.

Upon further investigation of the situation, the bylaws guiding the Rehabilitation

Offices were studied. Clause number 18 (Y) states that the training should take place in

Vocational Training

6%

Rehabilitation

certification54%

Disability ID28%

Referrals5%

No Answer7%

WHAT ARE THE SERVICES RECIEVED FROM THE REHABILITATION OFFICES?

DIRECTED TO PWDS


45

accordance to the occupations listed by Ministerial Decree No. 135 of 1984, taking in

considerations other popular professions in the market and private projects (MoSS, 1997). It is

apparent by the answers and the visits that took place to those offices, that there is a set of

available professions that the vocational specialists are familiar with and had been in use for

quite a long time. Through a closer interview with the office managers, they explained that

usually there is a set of entities that they may be dealing with to provide the training for PWDs.

According to an interview with a vocational specialist from Giza Rehabilitation Office, the

training that takes place usually varies between a set of professions such as packaging,

carpentry, plumbing and house painting (Giza Rehabilitation office, 2015). This explains and

shows the limitations that the Rehabilitation Offices have regarding the kinds of jobs that can

be offered to PWDs. There is a dependability on the availability of the employment places,

qualified trainers and willingness of private and public sector entities to make this training

program available. However, not only is the availability of training services a challenge but the

complications of each client’s case, the changing labor market and the country’s high

unemployment rate are all factors that further complicates this process.

Figure 5. 6 How do Rehabilitation Office employees determine the suitable job type for the

PWDs

Although only five of the 41 respondents who were said to have received a

rehabilitation certification from the Rehabilitation Office were directed to vocational training,

the qualification/ level of education question in the PWDs survey shows that 12 of the

respondents were non-degree holders (illiterate, primary & preparatory graduates). 19 of the

8

10

7

5

1 2 2 1 2

Unspecified According tothe kind ofdisability

According tothe

Educationalqualification

SkillsAssessment

Through thevocational

assessmentcenter

Past workexperience

Ministry ofManpower

Inconsultation

with thePWD

No answer

How do you determine the suitable job type for the PWD? (number of times it was mentioned by the Rehabilitation

offices employees)


46

respondents were holders of Technical Education Diploma and the rest varied between

technical bachelors, bachelors and master degree holders as shown in Figure 5. 7. This sample

is affected by MoSS’s selection of the PWD participants as reflected in the methodology.

Figure 5. 7 PWDs (respondents) qualification/ education level

However, when asked about the profession that they received training on, professions varied

between assistant technicians, technicians and services/ cleaners (11 responders). Furthermore,

they were asked to rate the effectiveness of the training they received or received by someone

they know. There were 32 responders to that question where the majority of the ratings varied

between average and poor (Figure 5. 8). This reflects how the majority of the respondents,

whether they received training or not, perceived the quality, appropriateness and usefulness of

the training provided by the Rehabilitation Offices to non-degree holders. Meeting the

expectations of the beneficiaries and empowering them to reach their full potential and

independence should be addressed. Therefore, a lot of effort needs to be exerted on behalf of

the Rehabilitation Office employees in order to build connections with the private sector to

make available a variety of training available. Different jobs are needed to suit the different

kinds of disability, different educational levels, geographic locations and gender of the PWDs.

Not only that but when adopting a rights based approach PWDs should be allowed self-

determination and an informed choice. PWDs should make their own choices and should be

made aware of all the employment options and potential opportunities. An individualized

employment plan can also be developed with each after career counseling takes place.

6%6%

12%

38%

2%

28%

8%

RESPONDENTS' QUALIFICATIONS/ EDUCATION LEVEL

Illiterate

Primary stage

Preparatory stage

Technician's Diploma

Post Secondary Institute

Bachelor degree

Master degree


47

Figure 5. 8 How do you (PWDs) rate the effectiveness of the training provided by the

Rehabilitation Offices?

Figure 5. 9 Do you (Rehabilitation Offices’ employees) follow-up with your beneficiaries?

The majority of the Rehabilitation Offices employees (69%) acknowledged that they

do not follow-up with their beneficiaries as shown in Figure 5. 9 whether they were degree or

non-degree holders. According to the offices bylaws, the vocational therapists are to follow up

with the work place upon the hiring of PWDs during the first year. This takes place so as to

know the suitability of the work environment to the PWDs and provide them with any needed

support to enhance their inclusion. Confirming that the effort done by Rehabilitation Offices

employees is not enough in the area of rehabilitation certification, vocational training and

employment, 43% of the Rehabilitation Offices employees said that the services provided to

PWDs doesn’t make them dependent but instead reliant on the government. It is only 9% of

16%

13%

26%

22%

23%

How do you rate the effectiveness of the training provided by the rehabilitation offices?

Directed to PWDs

Very Good

Good

Average

Weak

Poor

Yes27%

No69%

No Answer4%

DO YOU FOLLOW-UP WITH YOUR BENEFICARIES?(DIRECTED TO: REHABILITATION OFFICE EMPLOYEES)


48

the Rehabilitation Offices employees that feel PWDs are empowered by those services, since

they think it makes them live independently as shown in Figure 5. 10. More research should be

carried out targeting the non-degree holders among the PWDs to know more of the kinds of

training they received, their job search and job placement that took place in order to understand

the system and its gaps better.

Figure 5. 10 Do you think the services provided by the offices makes PWDs live

independently? (Directed to Rehabilitation Offices’ employees)

5.2 Issues relating to Human Resources

5.2.1 Disparity in Knowledge

As stated earlier, this thesis attempts to use a rights based approach in evaluating the

performance of the Rehabilitation Offices. Questions regarding explaining the procedures,

process and benefits of the services provided to PWDs is a cornerstone to the assessment of

these services. Of the 26 Rehabilitation Office employees surveyed 92% of them said that they

explain the benefits of disability IDs to PWDs receiving the services. However, when the

employees themselves were asked in the same survey about the benefits that the disability ID

grants its user, the answers were very weak (Figure 5. 11). First of all, there had been variation

in listing the benefits of the disability ID for those who mentioned the transportation benefits,

some employees mentioned that there is a discount on the metro and public transportation fees

and others said that it is totally for free. The same variation existed when mentioning benefits

received on plane tickets, where some mentioned a 25% discount while others did not mention

9%

43%

9%

13%

26%

Do you think the services provided by the office makes PWDs live independently?

(Directed to: Rehabilitation office employees)

Yes

No

It varies

Neutral

No Answer


49

it at all. Although one of the responders mentioned that PWDs would receive a “better treatment

at police stations”, when the GDSR department was asked about that there was no indicative

answer of a composed benefit that the card gives regarding that matter. This weakness that was

clear from the answers given in the surveys shows that employees do not have an equal

knowledge of the benefits being provided to PWDs through the disability ID cards and

therefore, would either be giving its users few information about its benefits or inaccurate ones.

Figure 5. 11 The benefits of Disability ID as mentioned by Rehabilitation Offices

This very much agrees to the dissatisfaction that is shown by PWDs when asked about the

information they are given at the Rehabilitation Offices, where 56% of the respondents claimed

that no one explained the benefits of the disability ID cards (Figure 5. 12). Also, when the

PWDs were asked to list the kinds of benefits that the disability ID gives them access to, the

majority of answers were not applicable to the questions asked and the second majority

believed that it did not give them access to any benefits as shown in Figure 5. 13. This shows

that its either that the PWDs thought that the ID cards gives them access to nothing or they are

not aware of its benefits since the Rehabilitation Offices’ employees did not inform them about

it.

19

7

3 1 3 3 35

1 302468

101214161820

Number of Times where the benefits is being mentioned by the Rehabilitation Offices employees

when asked about the Disability ID benefits


50

Figure 5. 12 Were the benefits of the Disability ID explained to you (PWDs) during your visit

to the Rehabilitation Offices?

Figure 5. 13 What are the benefits that the Disability ID entitles you (PWDs) to?

The researcher of this thesis visited three Rehabilitation Offices (two in Giza

governorate and one in Cairo). None of the offices had any signs on the walls listing neither

the services nor the procedures needed to complete the procedures for receiving services.

However, this is not an indicative sample to base a judgment on, especially that 92% of the

offices’ respondents said that the procedures were made available on a poster on sight. In

32%

56%

12%

Were the benefits of the Disability ID explained to you during your visit to the rehabilitation office?

Directed to PWDs

Yes

No

No Answer

0 1 2 3 4 5 6 7

Employment

Transportation

Exemption from hospital fees

Access to Beaches

Access to Gardens

N/A

Nothing

What are the benefits that the disability ID entitles you to?Directed to PWDs

Number of Mentions


51

addition to that 78% of the office respondents claimed that they had a list of the disability ID

benefits hanged on the wall. Yet also, this does not really go in accordance of the fact that the

Rehabilitation Offices’ employees are not fully aware of all benefits provided and its accuracy.

Also, when the PWDs were asked about whether the procedures are explained to them in

transparency when they go to the office for a service, the majority of the respondents denied as

evident in Figure 5. 14. This gives room for making a conclusion, that Rehabilitation Offices’

employees were not equally aware neither did they give the same information regarding the

procedures and benefits of services to their clients.

Figure 5. 14 Were the procedures explained to you (PWDs) upon your request of a service

from the Rehabilitation Office?

5.2.2 Clarity of roles and responsibilities: Rehabilitation

Offices’ responsibilities

This section discusses the clarity of roles and responsibilities to rehabilitation offices’

employees. Rehabilitation offices’ employees, directorate employees and NGOs seem to all

have a misunderstanding regarding the mandate of the Rehabilitation Offices’ and what its

employees’ roles and responsibilities are about. When Rehabilitation Offices’ employees asked

about the additional services that the offices can provide, existing services which are listed in

the Rehabilitation Offices’ regulations (mandates) had been mentioned ten times in the surveys

(Figure 5. 15). The answers varied between referring PWDs to the Ministry of Manpower

offices for assisting in employment opportunities, conducting social awareness, guiding/

referring PWDs to other services, provision of prosthetics services, and conducting awareness

sessions for PWDs and assisting PWDs in receiving disability pensions. All of these services

are ought to be part of the services that is to be provided by the Rehabilitation Offices. In

34%

54%

12%

Were the procedures explained to you upon your request of a service from the rehabilitation office?

Directed to PWDs

Yes

No

NoAnswer


52

addition to that, employment and the provision of better training opportunities to PWDs were

also mentioned, although stipulated on in clauses 18 and 19 (MoSS, 1997). This means that it

is either that the Rehabilitation Offices are not aware of their role or that they are incapable of

doing that. In anyway, this reflects that the Rehabilitation Offices are not doing their work as

they should.

Figure 5. 15 What are the additional services that you (Rehab offices’ employees) think

Rehabilitation Offices’ could provide?

Yet at the same time, when employees were asked about the ways to achieve that, financial

subsidies was of the highest mentions as shown in Figure 5. 16. This could imply that the

budget constraints had hindered the offices from doing their work and on the long run

disregarding their mandate. However, some of the tasks that employees should perform does

not require financial allocations such as assisting PWDs in getting disability pensions.

0

2

4

6

8

10

1

10

1 1 1

4

1

3

1

6

What are the additional services that you think Rehabilitation offices' could provide?

(DIRECTED TO: REHABILITATION OFFICE EMPLOYEES)


53

Figure 5. 16 What is needed to meet these additional services? (Directed to Rehabilitation

Offices employees)

Not only had the clarity of roles and responsibilities for Rehabilitation Offices’ employees been

problematic for them but also for the directorates’ employees. When the directorate employees’

were asked about the additional services that the Rehabilitation Offices can provide, 53% of

the answers given were discussing current services that are stipulated on in the Rehabilitation

Offices mandate (Figure 5. 17). These services ranged between; holding awareness seminars

targeting PWDs, their families and society, contacting Ministry of Manpower employment

offices for the recruitment of PWDs, contacting private sector businesses for finding vacant

job opportunities for PWDs, providing prosthetics services and determining the suitable

training for PWDs according to their kind of disability, which are all part of the Rehabilitation

Offices current mandate. However, the fact that the need for the same services were mentioned

by the Rehabilitation Offices’ employees as well as the directorate employees indicates the

need for these services, which therefore needs to be addressed by decision makers.

0

2

4

6

8

1

4

7

1

8

4

1

2

1

6

What is needed to meet these additional services?(DIRECTED TO: REHABILITATION OFFICE EMPLOYEES)


54

Figure 5. 17 What are the additional services that can be provided by the Rehabilitation

Offices? Directed to the directorates’ employees

Since the Rehabilitation Offices and the directorates themselves being service providers

and regulators suffer from a misperception to the services needed, the same situation would

exist for other NGOs working in the field. When the NGOs were asked about the additional

services that the Rehabilitation Offices need to provide to PWDs, 21 of the respondents

mentioned services that already existed in the mandate of the Rehabilitation Offices (Figure 5.

18). The answers discussed the proper and suitable training to PWDs, ID cards, prosthetics

services, awareness and employment. Of the new services that were mentioned was having a

guide for the kinds of jobs that suits the different kinds of disability as well as a announcing

the services of these Rehabilitation Offices among the people.

0% 20% 40% 60% 80% 100%

Existing Services

Holding camps and trips

Abide by the current services

Out of scope services

Increasing employees wages

Internet services

55%

3%

5%

21%

10%

5%

What are the additional services that can be provided by the rehabilitation offices?

(Directed to the directorates' employees)


55

Figure 5. 18 What are the additional services that Rehabilitation Offices need to provide to

PWDs? Directed to NGOs

5.2.3 The need to invest in service providers

When the PWDs were asked about the needed improvements or change measures to be taken

for providing better services at Rehabilitation Offices, the highest mentions revolved around

the human resources as can be seen in Figure 5. 19. PWDs talked about hiring the right

employees for the job, training employees on how to deal with PWDs was the highest in

mentioning and re-training employees to understand the value of what they do.

Figure 5. 19 In case you (PWDs) were a decision maker, what are the changes that you

would adopt to improve the performance of Rehabilitation Offices?

0

20

40

What are the additional services that rehabilitation offices need to provide to PWDs?

Directed to NGOs

Number of Mentions

0 2 4 6 8 10 12 14

HR Issues

Increasing Financial Subsidies

Existing Services

Structural Changes

Policy Changes

Unspecified

Nothing

Disciplinary Actions

In case you were a decesion maker, what are the changes that you would adopt to improve the performance of

rehabilitation offices?Directed to PWDs

Number of Mentions


56

The same case took place when NGOs were asked about the ways to improve the

performance of the Rehabilitation Offices. Human resources were mentioned 24 times in the

context of; a need for ongoing training programs, enhancement of their communication skills,

building their technical capacities, training them on sign language to be able to deal with deaf

and hard of hearing customers and treating PWDs in a decent manner (Figure 5. 20). There

were also several very important mentions to training employees on adopting a rights based

approach when dealing with PWDs and building their capacities to have equal opportunities

and chances as any other citizen to access his/ her rights. According to the CRPD, that Egypt

signed, “States Parties shall promote the development of initial and continuing training for

professionals and staff working in rehabilitation and rehabilitation services.” (Convention on

the Rights of Persons with Disabilities, 2006). Since Egypt had also ratified the treaty it is

ought to invest in its employees to be able to serve and empower PWDs from a rights based

approach.

Figure 5. 20 In case you (NGO employee) were a decision maker, what are the changes that

you would adopt to improve the performance of Rehabilitation Offices?

In order to better understand the background of Rehabilitation Offices’ employees whom were

surveyed, they were asked about their level of seniority and the number of years they spent working

in Rehabilitation Offices. The majority of the respondents, 69%, are the offices’ directors

themselves, whereas the number of working years spent in the offices was from 3 to 6 years, which

means that they are fairly new as reflected in Figure 5. 21. Although 58% of the office employees’

responders said that they receive periodic training from the NGOs they are affiliated to or from the

0 5 10 15 20 25 30 35

Societal Awareness

HR related issues

Improving procedures

Expanding services

General Reform

Monitoring and accountability mechanisms

Already existing services

Increasing financial subsidies

No Answer

In case you were a decesion maker, what are the changes that you would adopt to improve the performance of

rehabilitation offices?Directed to NGOs

Number of mentions


57

directorates or even from MoSS, 92% of the respondents did not determine the providers when

asked. Only 8% of all respondents said that it is provided by the GDSR. When asked about the

training the senior rehabilitation specialist who was interviewed said the following:

Training to the offices should take place from the GDSR part as well as from the

directorates. We (GDSR) send the training unit at MoSS the needed training modules and

ask for the allocation of budget to execute the needed training to Rehabilitation Offices.

She further explained how recently a training program took place targeting all employees in all

offices all over the governorates, yet only 42 of the employees showed up. According to her, this

training revolved around updating the Rehabilitation Offices’ employees with the latest ministerial

decree as well as the Community Based Rehabilitation (CBR) approach. It is part of the GDSR’s

roles to work on addressing the knowledge gaps that the office employees suffer from, yet we too

face challenges regarding that issue. She added that,

The low turnout numbers were a result of the shortage in the training budget as well as

the lack of motivation from the Rehabilitation Offices to attend due to their location at the

distant governorates.

For Rehabilitation Offices’ employees to attend such training programs they need to be given some

sort of motivation or at least a per diem that can cover their transportation costs. The GDSR can

also tailor an on the job training program that can suit them at their office locations. However, to

best decide on that matter the GDSR can approach the Rehabilitation Offices’ with surveys to

understand more about the reasons behind their low turnout rates as well as their motivation and

interests in the kind of training they are interested to receive. Also, when NGOs were asked about

opening communication channels between the specialized NGOs in the field and the NGOs holding

Rehabilitation Offices for the development/ reform of the offices, 78% welcomed that. Therefore,

the training that can be provided to the offices’ human resources can take place in collaboration

with the specialized NGOs in the field.

Figure 5. 21 Number of working years rehabilitation employees spent in Rehabilitation

Offices

43%

12% 19% 27%

FROM 3 TO 6 YEARS

FROM 7 TO 10 YEARS

FROM 11 TO 14 YEARS

MORE THAN 15 YEARS

Number of working years Spent at Rehabilitation Offices

(DIRECTED TO REHABILITATION OFFICE …

Chapter Six Study Findings on Structural Issues Affecting Service Delivery

58

Chapter Six: Study Findings on Structural Issues

Affecting Service Delivery

6.1 The involvement of multiple stakeholders

The involvement of several stakeholders in granting clients’ benefits had been deeply

discussed in the literature review, specifically the involvement of Ministry of Health and

Population (MOHP) in the process of entitlements. When the offices were asked about them

finding difficulties in defining and specifying the disability, 73% of them answered by a no.

Yet, based on an interview with the Minister Assistant for Social Protection and Development,

she said that there is a huge problem in determining the disability (MoSS Minister Assistant,

2015). There appears to be no clear and updated guide in use by the physicians assisting in the

process of medical examination, leaving this process to the subjectivity of physicians. The

Minister Assistant said that this issue is worked on now by a National Task Force committee

that aims to tackle the examination process to become more objective and fair. In the same

survey directed to the Rehabilitation Offices employees, 39% of the respondents were

concerned with the regulations and laws relating to the medical examination. The regulations

varied between determining the visually impaired (depending on his/her degree of sight),

ministerial decision 138 (MoHP) and other comments regarding the process of the medial

examination. These respondents are not aligned with the answer given earlier that no problems

arise in determining the kind or degree of disability.

On the other hand, 77% of the Rehabilitation Offices employees issue the certifications

based on the recommendations of the medical commission. 23% of those who answered said

that the medical examination is only guiding and not binding, since the process involves a

social examination as well as a medical examination. This shows how the process for

entitlements varies from an employee to another or an office to another in following the

recommendations of the medical commission. This has been a common problem discussed in

the literature and shows that the involvement of more than one stakeholder can create variations

in the perception of roles. This links back to the rubber stamping concept (Lipsky, 1980) since

the majority of Rehabilitation Offices employees surveyed adopt a phenomenon of adopting

the medical commission judgements due to the work overload, time constraints or poor

competency to make the right decisions.


59

In addition to that, the survey directed to the directorate employees shows that the

directorate had coordinated with the medical commission as a result of problems and

complaints from citizens (58%). These problems varied between insufficient or unclear

medical reports, mistakes in the diagnosis or corruption incidence, complaints by PWDs and

the long waiting lists. When the PWDs were asked about the length of times to receive the

services, 46% received the service in more than a month (Figure 6. 1). This can lead to

dissatisfaction from the PWDs end since it is quite a long time for one to receive a service. Any

delays or inconvenience experienced during the process from the medical examiners may be

easily blamed on the direct service providers (Rehabilitation Offices). Therefore, working out

any issues with MoHP may be very much needed for ensuring the satisfaction of clients to the

services provided.

Figure 6. 1What is the timeframe that took PWDs to receive the services?

6.2 Poor financial subsidies

The problem of inadequate funding is a very common one in the Egyptian social service

sector. “The lack of effective financing is a major obstacle to sustainable services across all

income settings” (World Report on Disability, 2011). The financial subsidies were an issue that

was recurrently mentioned especially in the survey forms directed towards the Rehabilitation

Offices’ employees and the directorate employees (Figure 6. 2 & Figure 6. 3). Financial

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

One Week

In 2 weeks

from 2 to 3 Weeks

A Month

More than a Month

Depedning on the services

No answer

8%

12%

6%

16%

46%

2%

10%

What is the timeframe for recieving the service?Directed to PWDs


60

resources was mentioned 18 times out of 26 by different Rehabilitation Offices’ employees as

an additional resource that would enable the delivery of better services. In reference to the point

made earlier about finding the suitable training opportunities, motivations must be given to

private sector companies in order to open its doors to training PWDs. Until there is a societal

awareness regarding the value of the PWDs in the job market, maybe higher financial offerings

can be provided to private sector companies to provide the training for PWDs on their premises.

This can be a temporary solution or a complementary one until there is more awareness from

society regarding the perception of PWDs capabilities and capacities. According to a vocational

specialist at Giza office;

We give the trainer 20 LE for the training provided to PWDs as well as 2 LE daily to

the PWD to cover his/ her transportation costs during the training period.

The financial allocations set for the training is very low, where the 2 LE would surely not be

able to cover for transportation costs especially that the trainees are PWDs who would endure

higher cost due to the inaccessibility of the transportation system in Egypt. Also for the

compensation that the trainer receives, 20 LE, is a low amount given his/ her capabilities and

experience in dealing with PWDs and providing them with training opportunities. Therefore,

the low financial allocations can certainly lead to a bad service delivery.

Figure 6. 2 What are the additional resources and capacities that could enable you (Rehab

office employees) to provide better services to PWDs?

During a visit to one of the offices in Cairo (El Sabaq, Heliopolis) the office director said that

Today is our last working day, we will shut down tomorrow since we have no money

tomorrow to pay for the workers’ wages.

Financial resources

43%

Training 24%

Communication and building

networks with other entities

31%

Other2%

What are the additional resources and capacities that could enable you to provide better services to PWDs

(Directed to: Rehabilitation office employees)

Financial resources Training Communication and building networks with other entities Other


61

Upon further questioning of the interviewee she explained that this was a result of the new civil

service law that has being adopted, ending the intergovernmental secondment (Rehabilitation

office manager, 2015). This means that the Rehabilitation Office was to recruit employees and

specialists which it cannot afford to pay for their wages. Although a couple of weeks after this

interview took place the new parliament of 2016 initially rejected the law, understanding this

issue is very important to understanding the loop holes in the system (Al Ahram Weekly, 2016).

The interviewee added that,

This office only receives a yearly subsidy of 4,000 LE to cover for rent, wages, bills,

supplies and all other expenditures. We were supposed to receive a yearly subsidy of

30,000 LE yet we received nothing until now.

Upon that, a senior rehabilitation specialist at GDSR was interviewed where she explained

that all the old established offices had been receiving very weak subsidies however the Ministry

decided that for the financial year 2015/ 2016 all subsidies will be raised to 30,000 LE a year

for those offices. The current subsidies for assigned projects now range from 30,000 LE to

100,000 LE depending on the year that these offices were issues. Even though this is a very

important step for a better service provision at these Rehabilitation Offices; ensuring its

implementation needs to take place as soon as possible, due to its important need. Another

problem that was spotted during the interviews with the GDSR management was that the

subsidy system is a fixed one that is not subjected to performance, offices’ needs or inflation

rates. This explains why some offices had been receiving 4,000 LE since the 1950s. This creates

a weak checks and balances system, as it disregards the needs of the offices nor equips them

with the tools they need to better perform.


62

Figure 6. 3 Biggest Challenges you (Rehabilitation Offices employees) face during your

work?

Figure 6. 4 If you were a decision maker, what are the measures that you (Rehabilitation

Office employees) would take to improve the performance of Rehabilitation Offices?

According to the Rehabilitation Offices’ employees, financial subsidies were determined to be

the measure that needs to be taken in order to improve the performance of the Rehabilitation

Offices (mentioned 11 times by different respondents as shown in Figure 6. 4). This was very

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Poorprovision of

services

Laws andregulations

Financialresources

MedicalExamination

Rejectingapplicants

workpressure

Lack oftraining

4

2

5

2

1 1 1

Biggest challenges Rehabilitation offices experiences when performing their work

(Directed to Rehabilitation offices employees)

0

2

4

6

8

10

12

6

11

1

5

3

1 12

1

4

If you were a decesion maker, what are the measures that you would take to improve the performance of rehabilitation

offices(Directed to: Rehabilitation office employees)


63

much confirmed on by the directorates, who is the responsible entity to collaborate with the

offices regarding the needed subsidies and their financial plans. The rehabilitation directorate

is mandated to gather the financial needs of the assigned projects and send them to the Ministry

of Finance requesting the financial allocations. Also when asked about the kind of support that

the directorate can offer to Rehabilitation Offices, the majority of 45% said that this can be

made through financial support and 29% expressed the need for technical support such as the

provision of training courses and information regarding the latest ministerial decisions that

concerns their works as evident in Figure 6. 5.

Figure 6. 5 What is the kind of support that the directorate can provide to the Rehabilitation

Offices? Directed to directorates’ employees

The question addressing the biggest challenge that face the performance of

Rehabilitation Offices further adds to the understanding of the directorate’s perspective

towards Rehabilitation Offices (Figure 6. 6). Financial support was again the major obstacle

that is believed to affect the performance of Rehabilitation Offices, which is then followed by

human resources problems that vary between weak salaries and the employees’ weak technical

capabilities. This means that the directorate employees also acknowledge the need for

additional financial resources but as was explained by a senior rehabilitation specialist at

GDSR, the final decision in determining the allocations is up to the Ministry of Finance.

However, upon an interview with the Minister Assistant for social protection and development,

she explained that:

MoSS acknowledges the weak financial subsidies that the Rehabilitation Offices receives,

but in order to increase these allocations there needs to be a well-studied plan put by

these offices as well as a set of Key Performance Indicators (KPIs) in which this money

0%10%20%30%40%50%60%70%80%90%

100%

Financialsupport

Technicalsupport

Didn't answer Easing theprocedure forreceiving the

financialsubsidies

providing thesuitable human

resources

45%

29%

16%5% 5%

What is the kind of support that the directorate can provide to the Rehabilitation offices?



64

can be granted based upon. And that is what the Ministry is working on this period.

(MoSS Minister Assistant, 2015)

Figure 6. 6 What is the biggest Challenge facing the performance of Rehabilitation offices?

Directed to directorates’ employees

Raising the financial subsidies based on criteria of KPIs would be a good investment in

the sector of social services. The provision of good services to the disabled would improve the

social and economic participation of people as well as their caregivers, which would contribute

to poverty reduction. This will as well result in a lower dependency on medical and welfare

services and will cause an increase in the labor market participation as a result of improved

functioning and independence.

6.3 Weak Monitoring system

The directorates are supposed to be the GDSR’s arm at each governorate. Their role

should not solely rely on looking for the wrongdoings and violations of the offices, but it should

also be one that works on enhancing offices’ performance. When asked about investigating the

citizens’ satisfaction regarding the services provided by the offices, 53% said yes while 47%

expressed their dissatisfaction. To allow for making an analysis in light of this very close

percentage, the senior rehabilitation specialist at the GDSR explained that there is no current

system at the directorates that test for customer satisfaction. This was very much confirmed

when the directorate employees were asked about the methodology to do so, 60% did not

answer, 21% said that they undertake this investigation through assessing complaints and 21%

58%

21%

10%5% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Shortage of financialsupport

Human Resourcesproblems

Medical Commissionrelated problems

No answer Shortage inTechnical Support

In your opinion, what is the biggest challenge facing the performace of Rehabilitation offices?



65

said that they do that by directly talking to customers or conducting meetings with them. There

has been no specification of the methodology used in asking customers and whether these

customers are the ones that visit the directorates or whether this takes place during the

employees’ visits to the Rehabilitation Offices. Therefore, this confirms the senior

rehabilitation specialists’ response, that there is no clear system for testing customers’

satisfaction. Also, 53% of the directorate employees said that there are no complaint boxes as

opposed to 47% who says there is. The monitoring of the complaints were said to take place as

follows; 47% follow up with the Rehabilitation Offices that the complaints came from, 37%

investigate the complaints at the directorates and 10.5% said that the complaints are sent to the

GDSR to be investigated (Figure 6. 7).

Figure 6. 7 How are the complaints monitored? Directed to the directorates’ employees

Through a deeper investigation of the Rehabilitation Offices’ monitoring and

evaluation systems, when asked about how they evaluate their performance; 25 % said that

they do it through follow-ups, 27 % through visits that included the investigation of the services

provided and writing of reports, 15% through the services provided (not specified) as shows in

Figure 6. 8. The follow up and visits are part of the directorates’ routinely tasks, these would

include periodic evaluations as well as investigating complaints. In the researcher’s effort to

know more about the directorate’s mandate, another Senior Rehabilitation Specialist at GDSR

was interviewed. He explained that the directorate employees are to inspect the number of

PWDs served, number of committees that were convened, collaborate with the offices’ in

solving their problems and is supposed to conduct training for the office’s employees (Senior

Rehabilitation Specialist at GDSR, 2015). One very interesting reply that was repeated nearly

five times by employees in their answers was the use of statistics. The answers included the

47%

37%

10.50% 5%0%5%

10%15%20%25%30%35%40%45%50%

Following up withthe office

Directorate wouldinvestigate the

complaint

The GASR wouldinvestigate it

No answer

How are the complaints monitored?(Directed to the directorates' employees)


66

number of PWDs served as stated by the office, the number of prosthetic devices being given

out and also the statistics given out by the Ministry of Manpower that shows the number of

PWDs in the job market. This shows how services are very much quantified in their evaluation

and less focus is given to the quality of services in terms of the treatment of employees to

PWDs for example.

Figure 6. 8 How do you (directorates’ employees) evaluate the performance of Rehabilitation

Offices?

Figure 6. 9 Actions taken against Rehabilitation Offices in case of violations (directed to the

directorates’ employees)

25% 27%

15% 5% 9% 9% 2% 3% 8%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%How do you evaluate the performance of rehabilitation

offices?(Directed to the directorates' employees)

47%

15% 9% 9% 10% 5% 5%0%

20%

40%

60%

80%

100%

Investigationswill take place

punishing thenegligent

Report to theGASR

No answer Acting inaccordance to

theregulations

and laws

Give awarning

Nothing

Actions to be taken against Rehabilitation Offices in case of violations



67

Out of few actions that were listed to be taken against Rehabilitation Offices as evident

in case of their violations; 47% did not specify any action to be taken, 11% did not answer and

5% said that they will do nothing as shown in Figure 6. 9 directed to directorates’ employees.

This reveals that the majority of the directorate employees are to take no concrete action or

clear measures against the Rehabilitation Offices in cases of violations. There has been a set of

questions directed to the directorate employees in order to understand more regarding the role

of the directorate in the service delivery and performance of Rehabilitation Offices. Although

74% of the employees said that they support the Social Rehabilitation Offices to perform better,

53% didn’t give any answer when asked how. In light of this same topic, 12 of 46 PWDs filed

complaints at Rehabilitation Offices and 14 of 40 PWDs filed complaints against Rehabilitation

Offices. When asked about the way these complaints were handled only 14 people responded,

where 71% of them claimed that nothing happened and no actions had been taken (Figure 6.

10).

Figure 6. 10 How was this complaint handled? Directed to PWDs

Attempting to know the kind of support or collaboration that could be taking place

between the directorates and Rehabilitation Offices, 58% said that they provide support to the

offices by connecting them with companies and bodies that can provide the suitable training

for PWDs. The difference between both responses is again a close one that shows that it is not

an installed regulation but one that may depend on what each directorate provides its offices

with. A further analysis can take place in later studies to know if the kind of support provided

to Rehabilitation Offices (besides the financial support) was subjective to personal

characteristics.

Lastly when NGOs were asked about the reasons behind the weak performance of

Rehabilitation Offices, the weak role of the government as a regulator was of the highest

frequency as shown in Figure 6. 11. Although MoSS isn’t the direct body delivering services

71%

29%

HOW WAS THIS COMPLAINT HANDLED?DIRECTED TO PWDS

Nothing

With Respect


68

to citizens, it is the regulator of these services. MoSS is supposed to follow up through its

GDSR, its General Administration for NGOs (regarding any financial violations) and its Social

Solidarity directorates to ensure that Rehabilitation Offices are abiding by the regulations and

are maintaining the quality of services provided.

Figure 6. 11 What are the reasons behind the weakness in the performance of Rehabilitation

Offices? Directed to NGOs

6.4 Reviewing assignment contracts and providing equal

opportunities

During the observations made while attending MoSS’s workshops, a lot of the NGOs attending

were unaware of the relationship governing the Ministry and NGOs holding/ running

Rehabilitation Offices. It was a surprise to many who got to know that the Ministry itself does

not implement itself direct projects, but instead does it through an NGO. In the survey, there

was a question directed to NGOs regarding their knowledge of the governing relations between

the NGOs and MoSS where half of the respondents said that they are not familiar with it. When

asked about the system of assigning projects by contract to NGOs for running long term

services (contracting out to NGOs) in return of financial subsidization, the majority of

responses were negative (Figure 6. 12).

0

5

10

15

20

25

30

weakness ofthe holding

NGOscapacities

Weak role ofthe

government(regulator)

Weak finacialresources of

holdingNGOs

Lack ofdemand on

rehabilitationoffices'services

Negativesocial

perceptionto PWDs

Directorate'sfailure inselecting

NGOs(assignmentcontracts)

All of thementioned

20

2826

7

19

24

14

What are the reasons behind the weakness in the performance of rehabilitation offices?

Directed to NGOs

Number of Mentions


69

Figure 6. 12 What do you think of the assignment contracts system that MoSS adopts?

Directed to NGOs

However, there is a misunderstanding regarding the government’s role in protecting and

empowering PWDs; where a lot of NGOs believe that the Ministry should be the direct entity

executing the projects/ programs and delivering services. This could be as a result of the

disappointment of these NGOs in the services provided by the assigned NGOs and therefore,

they believe that if the government directly delivers services it could be of a better quality. Yet,

57% of the respondents emphasized over the government’s role as a policy maker, rule setting

and regulator to the whole process according to the results in Figure 6. 13.

Figure 6. 13 What is the most important and fundamental role that the government should

play in the protection and empowerment of PWDs? Directed to NGOs

9%

21

%

21

%

16

%

12

%

4%

18

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Very Good Good Average Weak Poor Know nothingabout it

No answer

What do you think of the assignment contracts system that Moss adopts?Directed to NGOs

57%

43%

What is the most important and fundamental role that the government should play in the protection and

empowerment of PWDs? Directed to NGOs

Regulatory/ Policysetting/ Law maker

Providing Directservices to PWDs


70

75% of the respondents expressed their willingness to apply for an assignment contract in case

the government is open for that. However, when talking to the GDSR director, she explained

that this application process is always open for any NGO that has a status of public benefit

from the directorate. It was also clear during the workshops that NGOs were not aware of their

rights to apply for an assignment contract. The GDSR and the directorates are ought to raise

the NGOs awareness regarding their right to apply for assignment projects. The majority of

directorate employees (74%) believe that the assignment contracts which are given to current

NGOs (running Rehabilitation Offices) should be re-evaluated and reviewed. This is very much

needed as it would raise the sense of competition among NGOs which will enhance the quality

of services provided to PWDs. However, this does not only mean a revision to the current

NGOs on the assignment contracts but also to the content of the contracts itself. Some of the

rules governing some of the contracts are as old as the 1960s and didn’t witness any changes

since then. With a new approach to assignment contracts, new clauses needs to be drafted to

suit the current context.

The application process mechanism guiding assignment projects was addressed in the

surveys and the following suggestions were made by NGOs; opening competition between

NGOs in a public advertisement, clear conditions, choosing NGOs based on the directorates’

recommendations, forming a consultative committee of civil society (made up of civil society)

and reforming its assigned role as proportionately listed in Figure 6. 14.

Figure 6. 14 How would you recommend the assignment contracts to take place? Directed to

NGOs

0

20

40

60

80

PublicAdvertisments

Clear Conditions Directorates'Recommendations

ConsultativeCommittee

Reforming itsassigned role

20 18 17 13 10

HOW WOULD YOU RECOMMEND THE ASSIGNMENT CONTRACTS TO TAKE PLACE?

DIRECTED NGOS

Number of Mentions


71

However, the NGOs expressed that they would need support from the government to do so.

Most of the mentioned issues had been raised by current Rehabilitation Offices as needs to be

provided by MoSS as a mean of support as shown in Figure 6. 15. Therefore, this shows that

MoSS should not be only providing financial assistance to NGOs on assigned contracts but

also technical support is very much necessary for these NGOs. In case the GDSR does not have

the sufficient capacities to do so, building connections with specialized NGOs in order to build

capacities of the NGOs on assigned contract would be a good alternative. Opening the door to

specialized and successful NGOs to apply for assigned contracts in a public manner together

with raising the financial subsidies (to be appealing) would very much raise the sense of

competition between NGOs to perform better. “The more limited the competition, the less

incentive an industry or economy has to meet different market segment needs” (Johnson,

Herrmann, & Gustafsson, 2002). Moving away from the poor competition that exists in the

private sector, PWDs should be given better options so as not to feel trapped into accepting the

poor services provided by NGOs that existed from as long ago as the 1950s.

Figure 6. 15 What is the kind of support that you would need from MoSS in case you are on

assigned contracts? Directed to NGOs

6.5 Weak Social Support to PWDs

Social constructionist views on disability that is located in the minds of society, which

includes service providers and policymakers, very much affect their attitudes or policies

(Oliver, 1990). When PWDS were asked about the reasons for the weak services, in case they

10

28

117

41 2

6 6 5 3

05

1015202530

What kind of support would you need from MoSS in case you are on an assigned contract?

Directed to NGOs

Number of Mentions


72

believe so, the highest frequency was for the social perception (negative attitudes) towards the

issue of disability (Figure 6. 16). According to the World Disability report, “beliefs and

prejudices constitute barriers to education, employment, health care, and social participation”

(World Report on Disability, 2011). Also, when the NGOs were also asked about the reasons

behind the weakness of services provided (in case they do), 19 of the answers were about

society’s perception to PWDs that affect the overall interest in the issue. In reference to the

Social Valorization theory that was discussed in the literature review, the negative perception

that society holds of PWDs may be affecting how PWDs view/ perceive the services provided

by Rehabilitation Offices.

Figure 6. 16 What are the reasons for the provision of weak services by Rehabilitation

Offices? Directed to PWDs

These negative social attitudes to disability could be a reason affecting the quality of

services that is provided to PWDs by these offices as well as their inclusion in the job market.

As proven in the literature by Wolfensberger, those who are perceived with positive social roles

will be treated well by Rehabilitation Offices’ employees, while those who are perceived with

negative social roles will be treated badly by them. Furthermore, the quality of training that is

made available to PWDs at Rehabilitation Offices could be a result of their false perception

that PWDs are incompetent to perform. This is even evident in the use of linguistics in the

Rehabilitation law number 39 and the Rehabilitation Offices bylaws as has been discussed

earlier; “states that the office aims to qualify all categories of PWDs in a manner that is fit to

the abilities they have left, being physical, mental or psychological” (MoSS, 1997). This

0 10 20 30 40 50

Weakness of employees technical capacities

Weakness of projects' budget

Routine and bureacracy

Poor resources

Weakness in the directorate's supervisory role

Lack of societal and governmental interest

18

13

17

19

20

32

What are the reasons for the weak services?Directed to PWDs

Number of Mentions


73

reflects the perception of the law setters/ makers as well as the policy makers to the issue of

rehabilitation.

Also regarding employment, there were several mentions of the corruption that takes

place from business owners who register PWDs on their companies’ payroll to meet the quota

without them taking part in real work (Nancy, 2012). This has been mentioned several times

as well during the workshops. Business owners maybe holding a misconception (part of the

wider misconception that exist in society) that people with disabilities are less productive than

the non-disabled employees that they can hire. This may also be one of the factors why most

of them do not fulfil the 5% quota that is stated in the law. PWDs receive poor/ unsuitable

training, do not suit the job market and therefore are not employed. Using the SRV tool for

assessing the degree to which programs and service settings are in line with normalization

principles may be beneficial as it would determine the weak points that needs to be worked on

by policy makers. However, it seems clear in the case of Egypt that there is weak awareness

among the public regarding PWDs. An intense awareness campaign that can be led by the

government and the specialized NGOs could help change the negative attitudes.

Chapter Seven Conclusion and Recommendations

74

Chapter Seven: Conclusion and Recommendations

7.1 Conclusion

Assessing the performance of Social Rehabilitation Offices from a multidimensional

perspective resulted in very fruitful conclusions. It gives the reader an in-depth perspective of

the perceptions of each of the stakeholders’ views as well as the challenges that face a better

performance. The service providers (Rehabilitation Offices) and regulators (rehabilitation

directorate) had more positive perceptions of the services provided by the Rehabilitation

Offices than the direct beneficiaries (PWDs) and NGOs working in the field. After analysing

the questionnaires’ responses given by PWDs and NGOs’ it was concluded that not all

Rehabilitation Offices are performing with the same quality, efficiency and effectiveness.

There may be a lot of variation in how these offices are perceived by their beneficiaries,

especially in issues pertaining to accessibility, cleanliness as well as the treatment and

responsiveness of employees to citizens. However, most of the respondents from the

rehabilitation offices believe that more services and benefits can be provided to PWDs from

the offices, which means that they see more room for improvement.

There was a clear deficiency in the knowledge of the Rehabilitation Offices’ employees

regarding the benefits of the disability IDs given out to PWDs. This resulted in PWDs receiving

little information regarding the rights they are entitled to which therefore would lead them not

to exercise their full rights. PWDs are not given full information regarding the process and

procedures needed to receive the services which can lead to their disappointment. Regarding

the rehabilitation certification, highest service in use, more effort could be exerted by the

offices to establish connections and networks with employers for finding better training

opportunities to non-degree holders and employment opportunities to PWDs who received

rehabilitation certifications. This is to result in lower dependency by PWDs on the government

and help in achieving their independence.

The human resources at the Rehabilitation Offices were discussed by all stakeholders’

as an important issue affecting the performance of the offices. More investment in training

these employees needs to take place so that they would be able to provide better quality services

to citizens. Rehabilitation Offices and rehabilitation directorates seemed to have a confusion

regarding what their institutions are mandated to do, which affects the perceptions of the

beneficiaries (PWDs and NGOs) to the services received. All of this confusion in roles and


75

responsibilities were found to affect the quality of services provided as well as the efficiency

and effectiveness of the system in place.

Some factors were identified during the research, to be of structural nature that affect

the quality of service delivery; multiple stakeholders, poor financial subsidies, weak

monitoring system, assignment contracts and weak social support to PWDs. The involvement

of multiple stakeholders in the service delivery process was found to affect the perception of

the Rehabilitation Offices’ employees, which affects their understanding of the system and the

quality of the services they provide. Furthermore, it affects the beneficiaries’ (PWDs) as well

as the direct service providers’ (Rehabilitation Offices) perception of the services offered.

Financial subsidies were found to be very low compared to the expectations different

stakeholders hold of what these Rehabilitation Offices should be providing to its clients. There

is a weak monitoring and evaluation system in place, where the Social Solidarity directorates

are not fully aware of the role it should be performing. Another very important issue that

affected the quality of services provided was the structure of the system that pertained to

assignment contracts. Reviewing assignment contracts and opening new channels between

MoSS and experienced NGOs in the market was found to be needed for better service delivery.

Last but not least, the social awareness comes about as a problem affecting the services

provided to PWDs, their perception of these services, how they are positioned in the job market

and therefore their general self- esteem.

More issues can be examined in depth in later studies, such as the status of uneducated

PWDs, the kind of training they receive from Rehabilitation Offices, on what basis they are

assigned to it, as well as its effectiveness in finding job opportunities. Each of the factors and

issues that were found to affect the quality or perception of services can be separately studied

in depth to allow for a better detailed understanding of the system and the factors affecting the

quality of services. In order to draw deeper correlational analysis between the perceptions of

Rehabilitation Offices and factors such as the geographic location, gender of responder and

age; a bigger sample needs to be studied.

7.2 Recommendations

After this stakeholders’ analysis has been complete, there is a lot that can be done to

enhancing the performance of these Rehabilitation Offices. A first step to attracting the

required attention to the issue of disability and the provision of services that is necessary for

the empowerment and inclusion of PWDs in society, will be through credible national statistics.


76

In order to raise the awareness of society, policy makers and service providers; data and

evidence indicative of the situation should be made available. “A lack of rigorous and

comparable data on disability and evidence on programmes that work can impede

understanding and action” (World Report on Disability, 2011). Therefore, working on a

national database that would be reflective of PWDs numbers, kinds of disability, causes of

disability, geographic distribution and many other factors will be a step forward in the exerted

efforts to removing barriers facing PWDs. In the existence of this database, good and

comprehensive policies can be derived to address the real needs of PWDs.

“Problems with service delivery, poor coordination of services, inadequate staffing, and

weak staff competencies can affect the quality, accessibility, and adequacy of services for

persons with disabilities” were all identified as disability barriers (World Report on Disability,

2011). Building the capacity of these offices not only on the level of the personal capacities of

employees’ but also of the institutional and societal manner will guarantee sustainability

(Mirzoev, Green, & Van Kalliecharan, 2015). A societal awareness that includes institutions

and service providers needs to be built regarding the importance of economic participation of

PWDs. It is through the provision of good training that suits the labor market that PWDs can

reach their full capacities and genuinely participate in the job market. This will very much

reduce dependency as well as the overall poverty rate of Egypt.

The role of the regulator is very important at this stage, where a lot of work needs to be

exerted on behalf of the GDSR for the enhancement of the system. As a duty bearer, the

regulator, is to take the necessary measures to help in building the capacity of these parties.

Training needs to target the directorate employees first, regarding their role as a regulator as

well as their role to build the capacities of these Rehabilitation Offices. They need to also be

informed regarding the mandate of the Rehabilitation Offices, what is expected of them and

how should the service delivery process take place. Key performance indicators need to be put

by the NGOs holding/ running the Rehabilitation Offices and shared with the directorate’s as

well as the GDSR. Based on that, the directorates should be following up with these offices,

working with them to solve their problems and providing them with the technical support

needed. Directorate employees needs to pay more attention to citizen’s satisfaction through

carrying out surveys and reaching out to get their perspectives on services.

The Rehabilitation Offices’ employees needs to receive training sessions regarding

their roles and responsibilities. The GDSR needs to verify the information that has to do with

the benefits of the disability IDs with the related stakeholders. After that a publication should


77

be made with all the benefits that PWDs are entitled to upon receiving their IDs and should be

made available to every Rehabilitation Offices of the 207 offices. The GDSR should make it

mandatory for Rehabilitation Offices to post the guiding procedures for receiving a service as

well as the benefits of the IDs inside the offices.

Connections needs to be built on the governorate level of every office with private and

public sector companies and NGOs working in the field of disability. There needs to be a

coordination with the public and private sector businesses regarding the vacant jobs available

and providing the suitable and needed training for PWDs. The GDSR could work on providing

incentives to these companies, which does not have to necessarily be through monetary benefits

but can be through recognition. This will ensure the steering of efforts in the needed direction.

Similar to the Community Based Rehabilitation approach, a good referral system can be made

available at each office connecting PWDs with the NGOs that provide services in the same

district. For example, during the workshops one of the NGOs serving the physically disabled

had announced that in case there is any PWD in need of a chair; the foundation will provide it

along with capacity building and empowering services. Making the connections between the

service providers that may not be able to reach out to all PWDs and the PWDs that suffer from

poor services from the government counterpart would definitely narrow the existing gap in

services.

Meanwhile, MoSS should start an awareness program targeting PWDs and NGOs

working in the field of disability regarding the services it offers. PWDs should receive

awareness regarding the services available at MoSS and more specifically that the

Rehabilitation Offices should be providing. This will cause raising awareness that will increase

the demand of PWDs to the services and therefore will push the supply (Rehabilitation Offices

services) to meet this demand. A reassessment is to be made to the clauses guiding the

assignment contracts as well as the financial subsidies provided based on this contract to attract

skilled specialists (employees) and specialized NGOs (service providers). Making a public

announcement to NGOs that are interested in applying for an assignment contract should take

place to allow for good competition in the field. Based on the set KPIs a yearly competition

can take place between all offices, where one office for each governorate can be chosen for its

best practices to receive a financial award for its employees as an incentive. There is a huge

potential in Social Rehabilitation Offices that can be further utilized by adopting these

recommendations for better service delivery and empowerment of PWDs.

Bibliography

78

References

Against the civil service law? (2016, January 21). Al Ahram Weekly. Retrieved January 24, 2016,

from http://weekly.ahram.org.eg/News/15286/18/Against-the-civil-service-law-.aspx

Ahmad, M., & Ahmad, M. M. (2011). Measuring Support Provisions for People Living With

Disabilities in South Asia: An Accessibility Index. Journal of Social Service Research, 37(4),

439–455. http://doi.org/10.1080/01488376.2011.578034

Aubry, T., Flynn, R. J., Virley, B., & Neri, J. (2013). Social Role Valorization in Community Mental

Health Housing: Does It Contribute to the Community Integration and Life Satisfaction of

People with Psychiatric Disabilities? Journal of Community Psychology, 41(2), 218–235.

http://doi.org/10.1002/jcop.21524

Baril, R., Clarke, J., Friesen, M., Stock, S., & Cole, D. (2003). Management of return-to-work

programs for workers with musculoskeletal disorders: a qualitative study in three Canadian

provinces. Social Science & Medicine, 57(11), 2101–2114. http://doi.org/10.1016/S0277-

9536(03)00131-X

Bernabe-Ortiz, A., Diez-Canseco, F., Vásquez, A., & Miranda, J. J. (2015). Disability, caregiver’s

dependency and patterns of access to rehabilitation care: results from a national representative

study in Peru. Disability and Rehabilitation, 0(0), 1–7.

http://doi.org/10.3109/09638288.2015.1051246

Bualar, T. (2010). Disability rehabilitation policy in Thailand: explaining why it has come under

fire. Journal of Asian Public Policy, 3(1), 111–117.

http://doi.org/10.1080/17516231003634328

Camden, C., Swaine, B., Tétreault, S., & Bergeron, S. (2009). SWOT analysis of a pediatric

rehabilitation programme: A participatory evaluation fostering quality improvement. Disability

& Rehabilitation, 31(16), 1373–1381. http://doi.org/10.1080/09638280802532696

Chow, M. Y. K., Li, M., & Quine, S. (2012). Client Satisfaction and Unmet Needs Assessment

Evaluation of an HIV Ambulatory Health Care Facility in Sydney, Australia. Asia-Pacific

Journal of Public Health, 24(2), 406–414. http://doi.org/10.1177/1010539510384843

Creswell, J. W., & Clark, V. L. P. (2011). Designing and Conducting Mixed Methods Research.

SAGE.

Convention on the Rights of Persons with Disabilities. (2006). Retrieved September 17, 2015, from

http://www.un.org/disabilities/convention/conventionfull.shtml

http://doi.org/10.1080/01488376.2011.578034

http://doi.org/10.1002/jcop.21524

http://doi.org/10.1016/S0277-9536(03)00131-X

http://doi.org/10.1016/S0277-9536(03)00131-X

http://doi.org/10.3109/09638288.2015.1051246

http://doi.org/10.1080/09638280802532696

http://doi.org/10.1177/1010539510384843

http://www.un.org/disabilities/convention/conventionfull.shtml

Bibliography

79

Country Profile on Disability Arab Republic of Egypt. (2002, March 1). Retrieved September 17,

2015, from

http://siteresources.worldbank.org/DISABILITY/Resources/Regions/MENA/JICA_Egypt.pdf

Disability and health. (2015, October 17). Retrieved December 1, 2015, from

http://www.who.int/mediacentre/factsheets/fs352/en/

El Deeb, B. (2005, March 1). National Report on Disability Statistics in Egypt 21-23 March 2005.

Retrieved September 17, 2015, from

http://www.escwa.org.lb/divisions/sdd/events/21mar/egypt-e.pdf

Employment of People with Disabilities through FLSA Section 14(c). (n.d.). Retrieved September

17, 2015, from http://www.goodwill.org/wp-content/uploads/2013/06/Goodwill-14c-Fair-

Wages-Position-Paper.pdf

Gamal, R. (2014, September 19). المعاقون يهددون بثورة اعتراضا على نقل تبعية المجلس لوزارة التضامن. El

Dostoor. Retrieved October 11, 2015, from http://www.dostor.org/679571

Gregg G. van Ryzin, Douglas Muzzio, Stephen Immerwahr, Lisa Gulick and Eve Martinez . Public

Administration Review , Vol. 64, No. 3 (May - Jun., 2004), pp. 331-341 , Published by: Wiley

on behalf of the American Society for Public Administration Stable URL:

http://www.jstor.org/stable/3542598 (Not in Format)

Grigoroudis, E., & Siskos, Y. (2004). A survey of customer satisfaction barometers: Some results

from the transportation-communications sector. European Journal of Operational Research,

152(2), 334–353. http://doi.org/10.1016/S0377-2217(03)00028-6

Gruber, S., Titze, N., & Zapfel, S. (2014). Vocational rehabilitation of disabled people in Germany:

a systems-theoretical perspective. Disability & Society, 29(2), 224–238.

http://doi.org/10.1080/09687599.2013.796877

Glisson, C., Landsverk, J., Schoenwald, S., Kelleher, K., Hoagwood, K. E., Mayberg, S., … Health,

T. R. N. on Y. M. (2007). Assessing the Organizational Social Context (OSC) of Mental Health

Services: Implications for Research and Practice. Administration and Policy in Mental Health

and Mental Health Services Research, 35(1-2), 98–113. http://doi.org/10.1007/s10488-007-

0148-5

Hagrass, H. (2005). Definitions of Disability and Disability Policy in Egypt. Retrieved November

15, 2015, from http://disability-studies.leeds.ac.uk/files/library/Barnes-emw-Chapter-10.pdf

Hassali, M. A., Alrasheedy, A. A., Ab Razak, B. A., AL-Tamimi, S. K., Saleem, F., Ul Haq, N., &

Aljadhey, H. (2014). Assessment of general public satisfaction with public healthcare services

in Kedah, Malaysia. Australasian Medical Journal, 7(1), 35–44.

http://doi.org/10.4066/AMJ.2014.1936

http://siteresources.worldbank.org/DISABILITY/Resources/Regions/MENA/JICA_Egypt.pdf

http://www.who.int/mediacentre/factsheets/fs352/en/

http://www.goodwill.org/wp-content/uploads/2013/06/Goodwill-14c-Fair-Wages-Position-Paper.pdf

http://www.goodwill.org/wp-content/uploads/2013/06/Goodwill-14c-Fair-Wages-Position-Paper.pdf

http://www.dostor.org/679571

http://www.jstor.org/action/showPublisher?publisherCode=black

http://www.jstor.org/action/showPublisher?publisherCode=aspa

http://doi.org/10.1016/S0377-2217(03)00028-6

http://doi.org/10.1080/09687599.2013.796877

http://doi.org/10.1007/s10488-007-0148-5

http://doi.org/10.1007/s10488-007-0148-5

http://disability-studies.leeds.ac.uk/files/library/Barnes-emw-Chapter-10.pdf

http://doi.org/10.4066/AMJ.2014.1936

Bibliography

80

Hensing, G., Timpka, T., & Alexanderson, K. (1997). Dilemmas in the daily work of social

insurance officers. Scandinavian Journal of Social Welfare, 6(4), 301–309.

http://doi.org/10.1111/j.1468-2397.1997.tb00201.x

Integrated Programme to Promote the Rights of Persons with Disabilities in Egypt. (2011).

Retrieved 2016, from

http://lib.ohchr.org/HRBodies/UPR/Documents/Session7/EG/UNCT_EGY_UPR_S07_2010_

UNCTEgypt_document2.pdf

Johnson, M. D., Herrmann, A., & Gustafsson, A. (2002). Comparing customer satisfaction across

industries and countries. Journal of Economic Psychology, 23(6), 749–769.

http://doi.org/10.1016/S0167-4870(02)00137-X

Johnson, M. D., Herrmann, A., & Gustafsson, A. (2002). Comparing customer satisfaction across

industries and countries. Journal of Economic Psychology, 23(6), 749–769.

http://doi.org/10.1016/S0167-4870(02)00137-X

Klanghed, U., Svensson, T., & Alexanderson, K. (2004). Positive encounters with rehabilitation

professionals reported by persons with experience of sickness absence. Work, 22(3), 247–254.

Kumar, P. (2014, August 15). Disability Definition to Certification: The Hard Reality. Retrieved

September 17, 2015, from http://cafedissensus.com/2014/08/15/disability-definition-to-

certification-the-hard-reality/

Meadows, L., Bamieh, N., & Lord, J. (2015). Egypt. Retrieved January 9, 2016, from

http://www.adry.up.ac.za/images/adry/volume2_2014/adry_2014_2_egypt.pdf

Mirzoev, T. N., Green, A., & Van Kalliecharan, R. (2015). Framework for assessing the capacity of

a health ministry to conduct health policy processes—a case study from Tajikistan. The

International Journal of Health Planning and Management, 30(2), 173–185.

http://doi.org/10.1002/hpm.2222

Mohammad Suleiman Awwad. (2012). An application of the American Customer Satisfaction Index

(ACSI) in the Jordanian mobile phone sectornull. The TQM Journal, 24(6), 529–541.

http://doi.org/10.1108/17542731211270098

Mont, D. (2007, March 1). Measuring Disability Prevalence. Retrieved October 26, 2015, from

http://siteresources.worldbank.org/DISABILITY/Resources/Data/MontPrevalence.pdf

Montiel-Overall, P. (2007). Designing and Conducting Mixed Methods Research. By John W.

Creswell and Vicki L. Plano Clark. Thousand Oaks, CA: Sage Publications, 2007. 274 pp.

$79.95 (cloth); $39.95 (paper), ISBN: 1-4129-2791-9; ISBN: 1-4129-2792-7. Library &

Information Science Research, 29(3), 434–436. http://doi.org/10.1016/j.lisr.2007.02.003

http://doi.org/10.1111/j.1468-2397.1997.tb00201.x

http://lib.ohchr.org/HRBodies/UPR/Documents/Session7/EG/UNCT_EGY_UPR_S07_2010_UNCTEgypt_document2.pdf

http://lib.ohchr.org/HRBodies/UPR/Documents/Session7/EG/UNCT_EGY_UPR_S07_2010_UNCTEgypt_document2.pdf

http://doi.org/10.1016/S0167-4870(02)00137-X

http://doi.org/10.1016/S0167-4870(02)00137-X

http://cafedissensus.com/2014/08/15/disability-definition-to-certification-the-hard-reality/

http://cafedissensus.com/2014/08/15/disability-definition-to-certification-the-hard-reality/

http://www.adry.up.ac.za/images/adry/volume2_2014/adry_2014_2_egypt.pdf

http://doi.org/10.1002/hpm.2222

http://doi.org/10.1108/17542731211270098

http://siteresources.worldbank.org/DISABILITY/Resources/Data/MontPrevalence.pdf

http://doi.org/10.1016/j.lisr.2007.02.003

Bibliography

81

Nancy, E. (2012, June 16). People with Disabilities in Egypt: Overlooked and Underestimated.

Muftah. Retrieved December 14, 2015, from http://muftah.org/people-with-disabilities-in-

egypt-overlooked-and-underestimated/#.VpkHzBV97IV

Östlund, G. M., Borg, K. E., Wide, P., Hensing, G. K. E., & Alexanderson, K. A. E. (2003). Clients’

perceptions of contact with professionals within healthcare and social insurance offices.

Scandinavian Journal of Public Health, 31(4), 275–282.

http://doi.org/10.1080/14034940210165037

Population. (2015, February 10). Retrieved September 17, 2015, from

http://www.sis.gov.eg/En/Templates/Articles/tmpArticles.aspx?ArtID=9#.VpUIdBV97IV

Reiso, H., Nygård, J. F., Brage, S., Gulbrandsen, P., & Tellnes, G. (2000). Work ability assessed by

patients and their GPs in new episodes of sickness certification. Family Practice, 17(2), 139–

144. http://doi.org/10.1093/fampra/17.2.139

Salah, F. (2012, November 27). Disability in Egypt. Daily News. Retrieved October 11, 2015, from

http://www.dailynewsegypt.com/2012/11/27/disability-in-egypt/

Social Care. (2009, July 20). Retrieved January 9, 2016, from

http://www.sis.gov.eg/En/Templates/Articles/tmpArticles.aspx?CatID=730#.VpFfh-LMh_B

Söderberg, E., & Alexanderson, K. (2003). Sickness certification practices of physicians: a review

of the literature. Scandinavian Journal of Public Health, 31(6), 460–474.

Söderberg, E., & Alexanderson, K. (2005). Gatekeepers in sickness insurance: a systematic review

of the literature on practices of social insurance officers. Health & Social Care in the

Community, 13(3), 211–223. http://doi.org/10.1111/j.1365-2524.2005.00551.x

UNICEF. (2016). Human Rights-based Approach to Programming. Retrieved February 06, 2016,

from http://www.unicef.org/policyanalysis/rights/index_62012.html

United Nations Treaty Collection. (2016, January 9). Retrieved September 17, 2015, from

https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=iv-

15&chapter=4&lang=en#EndDec

UN News Centre. (2008, December 3). People with disabilities must play key role in development,

says Ban. Retrieved October 16, 2015, from

http://www.un.org/apps/news/story.asp?NewsID=29168#.VpT-kRV97IV

UN HRBA Portal. (2016). Retrieved February 06, 2016, from

http://hrbaportal.org/archives/topics/disability

Wen-Ta Chiu, Chia-Feng Yen, Sue-Wen Teng, Hua-Fang Liao, Kwang-Hwa Chang, Wen-Chou

Chi, … Tsan-Hon Liou. (2013). Implementing disability evaluation and welfare services based

on the framework of the international classification of functioning, disability and health:

http://doi.org/10.1080/14034940210165037

http://www.sis.gov.eg/En/Templates/Articles/tmpArticles.aspx?ArtID=9#.VpUIdBV97IV

http://www.dailynewsegypt.com/2012/11/27/disability-in-egypt/

http://www.sis.gov.eg/En/Templates/Articles/tmpArticles.aspx?CatID=730#.VpFfh-LMh_B

http://doi.org/10.1111/j.1365-2524.2005.00551.x

http://www.unicef.org/policyanalysis/rights/index_62012.html

https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=iv-15&chapter=4&lang=en#EndDec

https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=iv-15&chapter=4&lang=en#EndDec

http://www.un.org/apps/news/story.asp?NewsID=29168#.VpT-kRV97IV

Bibliography

82

experiences in Taiwan. BMC Health Services Research, 13(1), 1–22.

http://doi.org/10.1186/1472-6963-13-416

Wolfensberger, W. (2000). A brief overview of social role valorization. Mental Retardation, 38(2),

105–123. http://doi.org/10.1352/0047-6765(2000)038<0105:ABOOSR>2.0.CO

World Food Programme. (2016, January 12). Countries: Egypt. Retrieved January 12, 2016, from

https://www.wfp.org/countries/egypt/overview

World Programme of Action Concerning Disabled Persons. (2015, November 14). Retrieved from

http://www.un.org/disabilities/default.asp?id=23

World Report on Disability. (2011). Retrieved September 10, 2015, from

http://www.who.int/disabilities/world_report/2011/report.pdf

Ydreborg, B., Ekberg, K., & Nilsson, K. (2007). Swedish social insurance officers’ experiences of

difficulties in assessing applications for disability pensions – an interview study. BMC Public

Health, 7(1), 128. http://doi.org/10.1186/1471-2458-7-128

Retrieved January 2, 2016, from .(September 30 ,2009) .الرعاية الاجتماعية

http://www.sis.gov.eg/Ar/Templates/Articles/tmpArticles.aspx?CatID=816#.VpFgnOLMh_C

State Information Service. (2009, September 30). مصر ورعاية ذوي الاحتياجات الخاصة. Retrieved

September 17, 2015, from

http://www.sis.gov.eg/Ar/Templates/Articles/tmpArticles.aspx?ArtID=2305#.VpUHwBV97I

V

http://doi.org/10.1186/1472-6963-13-416

http://doi.org/10.1352/0047-6765(2000)038%3c0105:ABOOSR%3e2.0.CO

https://www.wfp.org/countries/egypt/overview

http://www.un.org/disabilities/default.asp?id=23

http://www.who.int/disabilities/world_report/2011/report.pdf

http://doi.org/10.1186/1471-2458-7-128

http://www.sis.gov.eg/Ar/Templates/Articles/tmpArticles.aspx?CatID=816#.VpFgnOLMh_C

Annex

83

Annex

Annex I: PWDs Questionnaire

إستبيان خاص بذوي الإعاقة

البيانات الأساسية

شخص ذوي إعاقة (1 الصفة؟

ولي أمر لشخص ذوي إعاقة (2

ذكر (1 النوع

انثى (2

المحافظة

المركز/ حى

طبيعة المنطقة

السكنية؟

ريفية (1

حضرية (2

صحراوية (3

ما هو نوع السكن

الذي تقيم به؟

منزل منفصل (1

شقة (2

غرفة/ غرفتين بمبنى (3

منزل مهدم. (4

عشة صفيح/ خشب (5

Annex

84

ملك (1 وضع المسكن؟

ملك مشترك (2

إيجار جديد (3

إيجار قديم (4

هبة (5

الوظيفة ) إن وجد (

أمى (1 المؤهل

إبتدائية (2

إعدادية (3

ثانوية (4

معهد (5

جامعى (6

فوق الجامعى (7

دون السن (1 الحالة الإجتماعية

أعزب (2

متزوج (3

ارمل (4

مطلق (5

18أقل من (1 العمر

30 – 18من (2

Annex

85

45 - 30من (3

50 -45من (4

60فوق (5

حركي (1 الإعاقةنوع

سمعي (2

عضوي (3

بصري (4

ذهني (5

البنود السؤال م

هل تم سؤالك عن درجة الإعاقة من 101

قبل ؟ أو تحديدها من جهة طبية

متخصصة

نعم (1

( 103لا ) فى حالة لا انتقل للسؤال (2

في حالة الرد بنعم، ما هي؟ 102

هل سبق وزرت مكاتب التأهيل؟ 103

نعم (1

( 127حالة لا انتقل للسؤال لا ) فى (2

لماذا 104

هل تم تلقي خدمة من مكاتب التأهيل 105

؟

نعم (1


اي مكتب؟ 106

Annex

86

هل تعرف احد تلقى خدمة من مكاتب 107

التأهيل؟

نعم .1

لا .2

قياس رضا المواطن عن خدمات مكاتب التأهيل:

تدريب مهني (1 المتلقى منهمما الخدمات 108

شهادة تأهيل (2

كارنيه إعاقة (3

تحويل (4

اخرى ، حدد ؟ (5

كيف كانت تجربتك؟ أو تجربة من قام 109

بتلقي الخدمة من معارفك ؟

جيدة جداً (1

جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

ماهى الطريقة التى تم التعامل معك؟ 110

أو تجربة من قام بتلقي الخدمة من

معارفك ؟ من قبل مقدم الخدمة هل هى

؟


جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

في حالة انك تلقيت تدريب، هل كان 111

التدريب المهني المتلقي مؤثر؟ أو

من قام بتلقي الخدمة من معارفك ؟


جيده (2

متوسطة (3

ضعيفة (4

Annex

87

سيئة (5

على اي مهنة؟ 112

113

في حالة انك ترى ان الخدمات

المقدمة ضعيفة، هل تعتقد ان ضعف

الخدمات المقدمة بسبب؟

ضعف إمكانيات العاملين الفنية (1

ضعف الميزانية الخاصة المشاريع (2

الروتين والدورة المكتبية (3

ضعف الموارد (4

المدرية في الإشرافتقصير من (5

عدم الإهتمام بمشكلة الإعاقة في (6

مصر من قبل المجتمع والحكومة

114

المكتب كائن في مكان يسهل الوصول

له )الإتاحة (؟


جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

جودة المكان من ناحية النظافة 115

؟ والمظهر العام


جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

Annex

88

إستجابة مقدمي الخدمة لطلبات 116

المواطنين ؟


جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

هل يتم شرح الحالة والتعامل مع 117

المواطن بشفافية؟

نعم (1

لا (2

هل حاول مقدم الخدمة دلك على 118

خدمات اخرى؟

نعم (1

لا (2

هل تم شرح مميزات الخدمة التي 119

تحصل عليها )مثل كارنيه الإعاقة(؟

نعم (1

لا (2

ماهى 120

أسبوع (1 ما المدة الزمنية لتلقى الخدمة؟ 121

في حدود أسبوعين (2

اسابيع 3 –من أسبوعين (3

شهر (4

أكثر من شهر (5

هل طلب منك دفع اي رسوم لتلقى 122

الخدمة بشكل سريع

نعم (1

لا (2

Annex

89

نعم، كم كانت ؟ في حالة 123

وبأي صيغة؟أو ماهو الأسلوب الذى 124

تم طلبه منك

هل تم معاملتك بأي شكل من أشكال 125

التمييز أثناء تلقيك الخدمة ؟

حدد 126

هل حاولت تقديم أي شكاوي لمكاتب 127

التأهيل من قبل؟

نعم (1

لا (2

نعم (1 أو ضد هذه المكاتب؟ 128

لا (2

129

تم التعامل مع هذه الشكاوى ؟ كيف

130

في إعتقادك ما هي نشاطات مكتب

التأهيل ؟

شهادات تأهيل )للعمل( (1

تدريب وتشغيل ذوي الإعاقة (2

كارنيه الإعاقة (3

تحويل لعلاج الطبيعي (4

تحويلات للأطراف الصناعية (5

Annex

90

ندوات وتوعية (6

أخرى (7

131

ما هي الخدمات الإضافية التي تتوقع

تلقيها منهم؟

في حالة انك صانع قرار كيف تتقترح 132

التحسين أو التغيير في طريقة مكاتب

التأهيل؟

أي تعليقات إضافية؟ 133

Annex

91

Annex II: Social Rehabilitation Offices Questionnaire

التأهيلان خاص بالعاملين بمكاتب إستبي


المحافظة

المركز/ حى

اسم المكتب التابع له

اسم الجمعية التابع

له


انثى (4

الوظيفة

الدرجة الوظيفية


إبتدائية (9

إعدادية (10

ثانوية (11

معهد (12

جامعى (13

Annex

92


عدد السنوات العمل

في مكاتب الإعاقة

سنوات العمل : ........... عدد

عدد ساعات العمل

اليومى ؟

عدد الساعات : ................


كيف تقيم خدمات مكاتب التأهيل لذوي 101

الإعاقة ؟


جيده (7

متوسطة (8

ضعيفة (9

5سيئة (10

5أقل من (1 عدد المترددين يومياً على المكتب؟ 102

2) 5- 7

3) 7 -10

أكثر (4

هل ترى مشكلة في التعرف وتحديد 103

الإعاقة من قبل الكشف الطبي او

مكتب الـتأهيل ؟

نعم (1

لا (2

هل يتم استخراج كارنيه الإعاقة بناءً 104

على نسبة أو درجة إعاقة معينة من

قبل القومسيون الطبي؟

Annex

93

هل يتم شرح المزايا للمواطن في حالة 105

منحه كارنيه إعاقة؟

نعم (1

لا (2

فقط اذا سأل المتلقى (3

هل يوجد اي ملصقات بالمكتب توضح 106

إجراءات الحصول على الخدمة؟

نعم (1

لا (2

هل يوجد اي ملصقات بالمكتب توضح 107

المزايا الحصول على كارنيه الإعاقة؟

نعم (1

لا (2

ما المزايا التي يحصل عليها ذوي 108

الإعاقة بالحصول على هذا الكارنيه؟

بخصوص شهادات التأهيل، هل يوجد 109

دليل يوضح انواع العمل المناسبة

لأنواع الإعاقة المختلفة؟

نعم (1

لا (2

كيف يتم تحديد نوع العمل المناسب 110

للمتقدم؟

هل تعتقد ان اللوائح والقوانين تمنح 111

لغير المستحقين المزايا المعطاة

للأشخاص ذوي الإعاقة؟

نعم (1

لا (2

هل تعتقد ان اللوائح والقوانين تمنع 112

المستحقين من تلقي الخدمات؟

نعم (1

لا (2

هل يتم المتابعة مع متلقين الخدمة 113

)مثل التوظيف؟(

نعم (1

لا (2

Annex

94

نعم (3 هل يتم حفظ ملفات المواطنين؟ 114

118لا ) فى حالة لا انتقل للسؤال (4

)

فى حالة نعم كيف ؟ 115

الإطلاع عليها؟ من له الحق في 116

هل يتم مشاركتها مع المدرية بشكل 117

منتظم ؟

نعم (1

لا (2

فقط ان طلب (3

هل تعتقد ان الخدمات والمزايا المقدمة 118

لذوي الإعاقة من مكاتب التأهيل

كافية؟

نعم (1

لا (2

هل تعتقد انها تمكنهم من ممارسة 119

حياتهم بشكل افضل أم تجعلهم

معتمدين على الحكومة؟

في حالة رفض منح المتقدم للبطاقات 120

او الشهادات، هل يتم شرح الاسباب

لهم؟

نعم (1


)

ورقى (1 في حالة نعم هل يتم ورقي؟ شفوي؟ 121

Annex

95

شفوى (2

ماهى السبل لتقديم التظلمات أو 122

الشكاوى ؟

هل يتم تدريبكم بشكل دوري من قبل 123

الجمعيات التابعين لها؟ وزارة

التضامن الإجتماعي؟ او اي جهات

اخرى؟

نعم (1

لا (2

حدد:

هل يوجد سهولة فى التواصل 124

والتنسيق مع المدريات ؟


جيده (7

متوسطة (8

ضعيفة (9

سيئة (10

ما اللوائح والقوانين التي تخص 125

ترى ضرورة تغييرها؟مكاتب التأهيل

ما الإمكانيات او الموارد الإضافية 126

التي قد تمكنك من تقديم خدمات أفضل

للأشخاص ذوي الإعاقة؟

موارد مالية (1

تدريبات (2

Annex

96

التواصل والتشبيك مع جهات (3

الخدمات المختلفة

أخرى ، حدد (4

ما هي أكبر التحديات التي تواجهك 127

اثناء تأدية عملك؟

إذا كنت صانع سيايات ما الأجراءات 128

التي ستقوم بها لتحسين الخدمة

بمكاتب التأهيل ؟

ما الخدمات الإضافية التي تعتقد من 129

الممكن ان تقدمها مكاتب التأهيل

للمعاقين؟

أليات تحقيق هذه الاقتراحات؟ 130

Annex

97

Annex III: Rehabilitation Directorate Employees Questionnaire

خاص بمدريات التضامن الإجتماعي إستبيان


المحافظة المديرية

التابعة لها


انثى (6

الوظيفة

الدرجة الوظيفية


إبتدائية (16

إعدادية (17

ثانوية (18

معهد (19

جامعى (20


عدد مكاتب التأهيل

التابعة لهذه المديرية

عدد المكاتب : ...........

Annex

98


كيف تقيم كفاءة وفاعلية مكاتب التأهيل 101

التابعة للمدرية؟


جيده (12

متوسطة (13

ضعيفة (14

سيئة (15

هل يتم قياس رضا المواطنين عن 102

الخدمة؟

نعم (1

انتقل للسؤال لا ) فى حالة لا (2

104 )

كيف 103

كيف يتم تقييم أداء مكاتب التأهيل ؟ 104

كيف تقييم علاقة المدرية بالجمعيات 105

المنفذة لنشاطات مكاتب التأهيل؟


جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

هل يتم الإستفادة بالبيانات المجمعة من 106

مكاتب التأهبل الخاصة بالأشخاص

ذوي الإعاقة؟ إستخدامها في دراسات؟

نعم .3

لا .4

Annex

99

هل يتم تدريب الموظفين على الَيات 107

التقييم و المتابعة لمكاتب التأهيل؟

نعم (1

لا (2

هل هناك صندوق خاص للشكاوى؟ 108

نعم (3

لا (4

كيف يتم تتبع الشكاوى؟ 109

ما الإجراءات المتخذة ضد مكاتب 110

التأهيل في حال الإبلاغ عن أي

تجاوزات؟

هل يتم التحقق من الاستحقاقات 111

المعطاة للمواطنين المتقدمين؟

نعم (1

لا ) فى حالة لا انتقل للسؤال (2

114 )

في حالة نعم كيف يحدث هذا؟ 112

نعم (1 وهل يحدث بشكل دوري؟ 113

لا (2

يتم دعم مكاتب التأهيل للقيام هل 114

بعملهم بشكل افضل؟

نعم (1


117 )

فى حالة نعم كيف ؟ 115

Annex

100

ما أنواع الدعم التي من الممكن أن 116

تقدمها المديرية للمكاتب؟

هل يتم التعاون مع مكاتب التأهيل 117

لتشبيكها مع الشركات والهيئات من

التدريب المناسب للأشخاص أجل توفير

ذوي الإعاقة؟

نعم (1

لا (2

هل يتم إرسال تقارير عن عمل المكاتب 118

من الجمعية المنفذة لهذا النشاط الى

المديرية؟

نعم (1

لا (2

هل سبق وتم التنسيق مع مدرية 119

الصحة في حالة حدوث أي مشاكل مع

القومسيون الطبي أو التقدم بالشكاوى

من قبل المواطنين ؟

نعم (1


121 )

فى حالة نعم أذكر الواقعة 120

في رأيك هل من المفروض ان يتم 121

إعادة النظر في عقود الإسناد الخاصة

بالجمعيات المنفذة لنشاطات مكاتب

التأهيل ؟

نعم (1

لا (2

في رأيك ما هي اكبر التحديات التي 122

تواجه عمل مكاتب التأهيل؟

ما هي الخدمات الإضافية التي من 123

الممكن أن توفرها مكاتب التأهيل؟

Annex

101

في حالة انك صانع قرار كيف تقترح 124

التحسين أو التغيير في طريقة مكاتب

التأهيل؟

أي تعليقات إضافية؟ 125

Annex

102

Annex IV: NGOs Questionnaire

الإعاقةإستبيان خاص بالجمعيات العاملة في مجال


المحافظة

اسم الجمعية

عنوان الجمعية

تاريخ إنشاء الجمعية

مجال عمل الجمعية

نوع الخدمات

المقدمة

العنوان


انثى (8

18أقل من (6 العمر

30 – 18من (7

45 - 30من (8

50 -45من (9

Annex

103

60فوق (10


سبق وسمعت عن اي نشاطات هل 101

تعقدها مكاتب التأهيل ؟

شهادات تأهيل )للعمل( (1

تدريب وتشغيل ذوي الإعاقة (2

كارنيه الإعاقة (3

تحويل للعلاج الطبيعي (4

تحويلات للأطراف الصناعية (5

ندوات وحملات توعية (6

أخرى (7

نعم (3 هل سبق وزرت مكاتب التأهيل؟ 102


)

لماذا ؟ 103

هل تعرف احد تلقى خدمة من 104

مكاتب التأهيل؟

نعم (3


هل الجمعية/ المؤسسة تعاملت مع 105

أي من مكاتب التأهيل؟

نعم .5

لا .6

تدريب مهني (6 ما الخدمات المتلقى منهم 106

شهادة تأهيل (7

Annex

104

كارنيه إعاقة (8

تحويل (9

اخرى ، حدد ؟ (10

كيف تظن كانت تجربة الأشخاص 107

ذوي الإعاقة في مكاتب التأهيل؟


جيده (17

متوسطة (18

ضعيفة (19

سيئة (20

هل تعتقد أن الناس من الممكن أن 108

يكونوا راضين أو غير راضين عن

مكاتب التأهيل ؟

راضيين (1

غير راضيين (2

لماذا؟ 109

هل تعتقد ان ضعف الخدمات 110

المقدمة بسبب؟

) يمكن اختيار أكثر من سبب (

ضعف قدرات الجمعيات (1

ضعف الدور الرقابي للحكومة (2

ضعف الموارد المالية للجمعية (3

عدم وجود إقبال على خدمات (4

المكتب

نظرة المجتمع للأشخاص ذوى (5

الإعاقة يؤثر على الاهتمام العام

بالقضية

تقصير المدريات في إختيار (6

الجمعيات ورفعها للوزارة في خطة

العمل المقترحة

Annex

105

كل ماسبق (7

في رأيك ما أهمية الدور التي تؤديه 111



جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

ما هي الخدمات الإضافية التي 112

تتوقع تقديمها لذوي الإعاقة من


في حالة انك صانع قرار كيف 113

تقترح التحسين أو التغيير في

طريقة عمل مكاتب التأهيل؟

هل تعلم النظم الحاكمة لعلاقة 114

الجمعيات التابع لها مكاتب التأهيل

بوزارة التضامن )خطة، دعم،

إعانة(؟

نعم (1

لا (2

ما رأيك في نظام الحكومة المتبع: 115

للإدارة إسناد مشاريع للجمعيات

والتنفيذ في مقابل تقديم الدعم

المالي للجمعيات ؟


جيده (2

متوسطة (3

ضعيفة (4

سيئة (5

لا أعرف ما هو (6

Annex

106

كيف تقترح ان يتم إسناد المشاريع 116

للجمعيات ؟

التنافسية بين الجمعيات في شكل (1

إعلان رسمي للتقدم

شروط واضحة (2

إختيار الجمعيات العاملة في المجال (3

بناءً على توصيات من المديرية

لجنة تشاورية تضم ممثلين مجتمع (4

المدني

إعادة هيكلة الدور المخطط لها (5

في حال إعلان وزارة التضامن عن 117

فتح باب التقدم في إسناد مشاريع

"مكاتب التأهيل" الى جمعيات

أهلية أخرى، هل من الممكن أن

تتقدم جمعيتكم لإدارة مكتب تأهيل؟

نعم (1

لا (2

في حالة الرفض وضح الأسباب؟

ما هي سبل الدعم التي تود 118

الحصول عليها من وزارة التضامن

الإجتماعي في هذه الحالة؟

هل ترى ضرورة فتح سبل تعاون 119

بين الجمعيات المتخصصة في مجال

نعم (1

Annex

107

الإعاقة والجمعيات المالكة لمكاتب

التأهيل من أجل التطوير؟

لا (2

في رأيك ما هو الدور الأساسي 120

والاهم للحكومة في حماية وتمكين

الأشخاص ذوي الإعاقة؟

رقابي وتنظيمي من خلال الإشراف (1

والدعم وصياغة اللوائح والقوانين

تقديم خدمات مباشرة للأشخاص (2

ذوي الإعاقة